Cass Review

Lord Sandhurst Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, my focus is on the misuse of drugs for unlicensed purposes. It is perfectly proper and sensible that drugs are used for unlicensed purposes in the right circumstances. For example, in the case of children, drugs are not tested on them; they have been tested and licensed for use on adults, and they are used quite properly—it is called “off-label”—for children for the same purposes. However, in this case, as Cass has found at paragraphs 20.11 and 20.12 of her report, in the case of puberty blockers there was what she describes as a “system weakness” in that off-label use. It went beyond the usual level of permissiveness in extending use to a very different indication. So she has recommended, in recommendation 32:

“Wider guidance applicable to all NHS services should be developed to support providers and commissioners to ensure that innovation is encouraged but that there is appropriate scrutiny and clinical governance to avoid incremental creep of practice in the absence of evidence”.


I have two questions. What steps are the Government taking to implement this important recommendation as a matter of urgency? It will not just be puberty blockers; there will be drugs used in a range of fields. Who will be charged with the responsibility for creating this guidance and then implementing it?

[Lord Markham (Con)]

With the wonders of modern technology, I hope I can answer two questions in one. On the previous question, yes, the regulators have been communicated with about making sure that it is very clear. On that point, I say to my noble friend that the regulators have been charged with making sure that very clear guidelines are put out on the drug use that he mentions; those are being set right now. While I am clearing stuff up, to be clear and to save me correcting it later, it will be eight clinics in total when they are all there; I might have said that it was eight additional clinics.

King’s Speech

Lord Sandhurst Excerpts

Thursday 9th November 2023 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I shall address two matters today. Each concerns education, on which this Government have rightly placed a premium, but there remain significant areas which the proposed legislative programme does not address. Indeed, we do not have an education Bill. I hope that time may yet be found to address them none the less.

The first point I make concerns the right of parents and prospective parents to know what their children are being taught in schools. In RSE, too many schools still have contracts with outside providers of teaching materials whose terms purport to forbid teachers from showing copies to parents or others who want to know what is being taught. That is often because the provider is really a lobby group promoting unorthodox ideas in sex education or race theory. They do not want the public to see what is being taught. I do not need to cite examples; the press in recent months has been full of this.

When the now defunct Schools Bill came before the House last year, I, with other noble Lords from across the House, from all four Benches—three anyway—tabled an amendment in Committee which would have given parents the statutory right to see such materials. That came to nothing when the Bill died but, on 31 March this year, the department wrote to schools saying that parents should be able to view all curriculum materials. That has gone further now: the department sent a stronger circular on 23 October, three weeks ago. The first letter said:

“The Department is clear that parents should be able to view all curriculum materials. This includes cases where an external agency advises schools that their materials cannot be shared due to restrictions in commercial law, or a school’s contract with the provider prohibits sharing materials beyond the classroom”.


I welcome that, but it is not a substitute for legislation. First, legislation has a permanence which cannot be provided by departmental guidance. Secondly, a letter from a Minister does not bind the courts; it is possible that the propositions of law set out in a circular will fail to stand up in some future litigation. Thirdly, the experience to date has been that circulars and guidance from the department have not been enough to secure compliance with the policy of transparency. Fourthly, it does not address the position of prospective parents—those who have yet to send their children to a school—only the rights of parents of current pupils. Finally, the propositions in the circular themselves are subject to some limitations and qualifications.

The right way to provide for the rights of parents and prospective parents hoping to make an informed choice of school is a parental rights Bill. This will properly protect their rights under Article 2 of Protocol 1 of the European Convention on Human Rights, as reinforced by the court in Strasbourg. Such a Bill is to be found on the website of the Society of Conservative Lawyers, whose chair of research I am. I commend it to the House. Failing that, there is the Bill recently presented in the other place by Miriam Cates MP, which I believe deserves support. A critical point in its favour compared to the circular is that it would require all RSE teaching materials from external providers to be either published in the public domain or obtainable on payment of a modest fee.

I move briefly to my second topic, the vital life skill of financial awareness. I have addressed the House on this before but I want to urge the Government forward. There is a clear and pressing need to include financial education in primary schools, not just secondary schools. As the Centre for Social Justice has explained, money habits and behaviours that will stick for life are formed by the age of seven. However, two-thirds of primary school children receive no financial education. The Centre for Financial Capability has made the same points in its report this month on financial literacy in the community. We know as adults that we have to manage rent, mortgages and a range of household bills. Children must be equipped for this and it must start young. Too many school leavers still leave ill equipped because the grounding has not been laid at the outset. These skills must be embedded young. While financial education is now taught in secondary schools, many teachers say that too many leave school with an inadequate grasp of it. We must do something about it. It must start in primary schools and I urge this Government to do something now.

General Medical Council: Internal Guidance

Lord Sandhurst Excerpts

Tuesday 17th October 2023 Lords Chamber

[Lord Cormack (Con)]

My Lords—

[Lord Sandhurst (Con)]

My Lords—

[Baroness Williams of Trafford (Con)]

My Lords, my noble friends should come to a gentlemen’s agreement on who is going first.

[Lord Cormack (Con)]

My Lords—

[Lord Sandhurst (Con)]

My Lords—

[Noble Lords]

Oh!

--- Later in debate ---

[Lord Markham (Con)]

I think the noble Lord makes the point very well. I do not think I have anything to add, apart from basic agreement.

[Lord Sandhurst (Con)]

My Lords, the GMC may be independent but it is a creature of statute and should remember that. Parliament can change its statutes at any time. Are we to anticipate that, if the doctors’ regulator —this creature of statute—refers to its female staff, by which I mean women, as chest feeders or people with cervixes, the Minister will make it plain that this language from the medical regulator is unacceptable?

[Lord Markham (Con)]

I am quite happy, as mentioned previously, to talk to the GMC about its use of language, the importance of the use of correct language and the clear feelings of all of us in the House today about women who are women and mothers, and men who are male and fathers. I will leave it to the GMC as to how it deals with staff matters, but I will be very clear on medical issues and the belief of all of us here in this House.

Gender Identity Services: Children and Young People

Lord Sandhurst Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

I feel I am probably outgunned to some degree by the noble Lord. I would like to make sure that I answer that in the proper way and give him a detailed written response. I am happy to follow up, because I want to make sure that I am answering in completely the right way.

[Lord Sandhurst (Con)]

My Lords, the Times of 23 February reported that GIDS patients were still receiving puberty blockers. What arrangements are in place—as recommended by Dr Cass in her report—to monitor patients who receive treatment, both during it and in subsequent years by way of follow-up, to ensure a proper longitudinal study of the effects?

[Lord Markham (Con)]

My noble friend is absolutely correct: one of the main findings from the Cass review was that more research has to be done in the whole space of puberty blockers. The NHS is moving on that as we speak. At the same time, I can assure the House that, from now on, no puberty blockers can be prescribed unless they are part of that research programme, because it is vital that that does not happen as a matter of course until we understand far more about this subject.

GP Appointments

Lord Sandhurst Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

As mentioned, we are increasing the number of doctors. We have 2,000 more versus 2019. The House will be pleased to know that that is a key part of the workforce plan for recruiting and retaining more doctors. As to comorbidities and deprived areas, clearly that is the role of the integrated care boards. They are set up very much to understand the needs of their areas and to make sure that they are looked after properly. In a lot of cases that means investing in primary care. We all know that a lot of the reason why we have a lot of people in A&E is that they cannot get GP-type services, so getting upstream of that issue and investing in primary care is the direction in which we need to go.

[Lord Sandhurst (Con)]

My Lords, it is often forgotten that general practitioners, unlike salaried NHS doctors, are self-employed contractors under contract to provide services. What plans, if any, do the Government have to review the existing GP contract to ensure that new terms are imposed to require better delivery of services by general practitioners?

[Lord Markham (Con)]

My understanding is that the new GP contract is part of live conversations with the BMA that we are about to get into—I think it is over the summer that those negotiations will start to take place. Within all of that, we will be looking at all those sorts of things in terms of how we want to see the GP service evolve. At the same time, we will be talking openly to the BMA about what it wants for its doctors, so that we get an outcome that works well for both sides.

Osteoporosis: Early Detection

Lord Sandhurst Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for bringing this to my attention. Clearly a 28% reduction is impressive and something that we should take seriously. If she can give me the reference, I will definitely take it up and write back.

[Lord Sandhurst (Con)]

My Lords, is not exercise when growing as an adolescent, particularly impact exercise, important for stimulating bone growth? Should more not be done to encourage impact exercise among children and teenagers, particularly among girls, who do not always want this—in other words, running, jumping on the spot and so on?

[Lord Markham (Con)]

As a player of rugby, which probably has far too many impacts, I agree with the sentiment that exercise is always a good thing, whatever stage of life one is at. Also, we all know that vitamin D is a vital part of helping against bone weaknesses. Things as simple as spending more time in the sun in summer or taking vitamin D supplements in the winter are vital prevention methods. I agree about exercise, but all these measures should be rewarded and promoted.

Health and Care Bill

Lord Sandhurst Excerpts

Committee stage
Wednesday 9th February 2022 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I speak in support of Amendment 297G. This will give much-needed statutory force to what has been long-stated NHS policy, but which has not always been properly implemented. This is why we will demonstrate why current guidance is equivocal upon it. I hasten to add that I am not a conspirator against trans people—I make that absolutely plain. I resent the suggestion that those speaking in support of this amendment might be thought to be.

The current NHS guidance, which goes a long way back historically, as we have heard, is in these terms:

“All providers of NHS-funded care are expected to prioritise the safety, privacy and dignity of all patients”—


we all agree with that. It continues:

“Adherence to this guidance is an essential part of this.”


It then goes on to talk about mixed accommodation:

“What is a mixed-sex accommodation breach? … Patients should not normally have to share sleeping accommodation with members of the opposite sex. Patients should not have to share toilet or bathroom facilities with members of the opposite sex. Patients should not have to walk through an area occupied by patients of the opposite sex to reach toilets or bathrooms; this excludes corridors.”


This is what hospitals should be doing. In particular, I ask your Lordships to note the terminology and the use of the terms “mixed-sex” and “opposite sex”. Sex, we all know, is physiological; it dates from conception and is not assigned at birth or at some later date. The definitions of man and woman in Sections 11 and 212 of the Equality Act refer to sex, not gender. Further, Part 7 of Schedule 3 of the Equality Act provides at paragraph 27:

“A person does not contravene section 29 … by providing a service only to persons of one sex if … the service is provided at a place which is, or is part of … a hospital, or … the circumstances are such that a person of one sex might reasonably object to the presence of a person of the opposite sex.”


Hospitals are free to do what they wish and to prioritise single-sex wards. However, in contradiction to the law, physiology and the primary guidance to which I have referred, annexe B of the guidance provides:

“Transgender … is a broad, inclusive term referring to anyone whose personal experience of gender extends beyond the typical experiences of their assigned sex at birth.”


We are moving from sex to gender, and it is premised on a scientific flaw. Building on that error, it continues:

“If patients are transferred to a ward, this should also be in accordance with their continuous gender presentation (unless the patient requests otherwise).”


The guidance is not saying that they should be put somewhere safe or separate but that they should go to the ward that they wish. If they say a women’s ward, they go to a women’s ward. That is not what Secretaries of State have said and not what has been policy for 20 years, and it departs from the primary guidance. I submit that it is wrong—and I am sure noble Lords will all agree. It discriminates against women who do not wish to be in the presence of someone who is an intact male, as some trans people will be.

Amendment 297G is perfectly reasonable and absolutely right, and I urge noble Lords to adopt it.

[Lord Blencathra (Con)]

My Lords, I support the amendments in the names of my noble friend Lady Nicholson of Winterbourne and myself. I pay tribute to her for raising this issue of vital importance to women, and for being their champion over many years in the face of some bitter attacks from a minority of trans zealots.

I must say to the noble Baroness, Lady Brinton, that I resent the implication that somehow we are attacking trans people in these amendments. There is no conspiracy against them; we want equal treatment for everyone in the NHS. If there is any conspiracy it seems to be to demean the status of women. I also say to her that, yes, if these amendments were accepted, NHS policy would have to change to comply with the law of the land—the Equality Act 2010—because it is in breach of the exemptions in that Act at the moment.

As we all know, there is no real privacy in hospitals, however hard they may try. If one ties that funny gown the wrong way, like a dressing gown, one’s front is exposed; if one ties it properly, the rear is exposed. Even when one is recovered and wearing pyjamas or female bed attire, it is impossible in a hospital to carry out the routine of getting into and out of bed, and using the washing and other facilities, without some part of one’s anatomy being exposed. Many patients neglect to close or lock washroom doors. Some with mental health problems may express sexual disinhibition. When doctors come round and pull the screens around the bed, of course, there is still the discussion of one’s condition and the medical profession’s obsession with bowel movements, as we all know about.

I am old enough and ugly enough not to care what parts of my body medical professionals see. They have all poked, prodded and cut out various bits of it over the years so I am reasonably immune to embarrassment with them. However, I would find it highly embarrassing if I found a woman, or a man declaring as a woman, in the next bed and encountered her in the ablutions. Of course, it is highly unlikely that I would meet a woman since an infinitesimally small number of women identify as men, but many more men identify as women.

All my life, there has been an NHS policy of single-sex wards and Governments of all colours have been slammed on those occasions when men and women were sharing hospital accommodation. The policy is that patients should not have to share sleeping accommodation, nor toilet or bathroom facilities, with members of the opposite sex. The operative word is “sex”—biological sex, not gender.

Since we are speaking about women, sex and hospitals, I will put some astonishing medical information on the public record which has resulted in some women being sacked or abused for saying it. I stand to be corrected by medical experts present. I believe that only women can give birth to children, since only women have wombs. No matter what one declares one’s gender to be, only men get prostate and testicular cancer. Only women can breastfeed their children and men who have chests cannot. The sex of babies is not assigned at birth. Babies are born as boys or girls, and that includes those born with those rare congenital disorders of sexual development. No one decides to assign male or female to a baby; they are born that way, so that is why the term “sex assigned at birth” is so offensive.

In the course of daily life, working in most jobs or going to the pub et cetera, sex and gender do not matter and one can call oneself what one likes. But when it comes to medical treatment, two vital factors can determine the diagnosis and that treatment. These factors are age and sex. Sex is the only thing which matters medically, not gender, and that was always the case until the mistaken guidance issued in September 2019. The NHS always recognised that single-sex accommodation was essential not only for a patient’s privacy and dignity but for their treatment and recovery. Doctors recognised that patients in distress for whatever reason cannot recover as easily as those who are comfortable in their surroundings, and who are not fearful of people of the opposite sex seeing their body at a time when they are at their most vulnerable. That is why the NHS guidance stated in absolutely unambiguous terms:

“There are no exemptions from the need to provide high standards of privacy and dignity at all times”.


As my noble friends have pointed out, it all went haywire in annexe B of the guidance, which failed to implement the Equality Act 2010 and said that trans people should be accommodated according to their self-identification, which the guidance says

“may not always accord with the physical sex appearance of the chest or genitalia”.

It goes on to say that

“pre-operative transgender people should not share open shower facilities.”

I am sure that Jewish or Muslim women find it immensely reassuring that they can be in a shower with a man, so long as he has had some operation on his genitalia.

This is the advice I received from a Jewish expert in medical ethics. The religious requirements of Orthodox Judaism mandate single-sex facilities for both men and women where people are likely to be in a state of even partial undress. This includes the requirement for single-sex hospital wards, bathrooms and changing rooms. The distress, both psychological and spiritual, that is likely to be caused to Orthodox Jews if they are forced to share facilities with members of the opposite sex is considerable, as is the impact on the patient’s family. Orthodox Jews are protected under the Equality Act on the basis of their religious belief. It would be wholly unacceptable if an Orthodox Jewish woman were to be counselled by NHS staff into accepting the presence in the bed next to hers of a male patient who identifies as transgender. That is the advice I have received on Orthodox Judaism. I do not know, but I assume that the requirements of Islam are similar.

The needs of these women should apply to all women, whether religious, atheist or pagan, and not just those with particular religious beliefs. What is wrong with NHS guidance Annex B is that the Equality Act 2010 specifically exempts hospitals and the provision of joint services where a joint service for persons of both sexes would be less effective and in circumstances where a person of one sex might reasonably object to a person of the opposite sex.

I say to the Minister that the law is clear: women have the right to be kept in hospital accommodation with only other women. One of course exempts intensive care units, where patients are unconscious or nearly unconscious; their medical treatment is best served by all being in the same specialist unit together. I call on my noble friend the Minister to withdraw this flawed guidance on transgender patients and instruct the NHS to comply with the law of the land.

I will say a brief word on Amendment 297F. I have read the reports that some NHS trusts have logged women as transphobic, when all they have done is request single-sex accommodation and not to be in a bed next to a man who identifies as a woman. There are a few reports of this. It is nothing to do with anyone on Twitter posting a rant about some hateful person next to them; it is ordinary women saying, “Please can I be in a room where I do not have a man next to me?” It is as simple as that. I am told they are recorded as being transphobic, merely for making that request.

I asked my noble friend, in a Written Question, what evidence he has of this. He said that unfortunately —or fortunately—the NHS does not collect this information centrally; it is left to the trusts. I accept that, but I would like my noble friend to issue an instruction to all NHS trusts that it is perfectly legal for a woman to make this simple request and that she must not be stigmatised as transphobic for asking. That is completely separate and quite different from anyone who makes racist, offensive, threatening or genuinely hateful transphobic remarks.

There must be no discrimination against trans people in hospital or discrimination against anybody. Our amendment makes it clear that trans people must receive equal medical treatment, but that does not mean that their gender identity wish must be accommodated over and above the wishes of people of the opposite sex. If there were a finely balanced conflict of rights here, I would take the view that those demanding it is their right that their gender identify should take precedence over women’s sex are wrong and the rights of women should prevail. But there is no fine balance here. In my opinion, the NHS is breaking the Equality Act 2010, and I request that it obeys it as soon as possible.

Health and Care Bill

Lord Sandhurst Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I add my congratulations to the noble Lord, Lord Stevens of Birmingham, on his very uplifting maiden speech.

I shall direct my remarks to Clause 4. This inserts a new provision into Section 13A of the National Health Service Act:

“The objectives that the Secretary of State considers NHS England should seek to achieve which are specified in subsection (2)(a) must include objectives for cancer treatment defined by outcomes for patients with cancer, and those objectives are to be treated by NHS England as having priority over any other objectives relating to cancer”.


This is a very specific and important mandate. Henceforth, successful management will be judged by “outcomes for patients”: how many survive and for how long.

Let me explain why this is important. For the first time, cancer survival rates from the date of diagnosis will be given priority over other objectives in the treatment and management of cancer. Hitherto in respect of cancer this country has focused for too long on targets, such as the two-week wait to see a specialist after a referral and the 62-day wait from referral to first definitive treatment. Those targets are not irrelevant or unimportant, but they are only part of the picture and have distorted the way we have managed cancer. They have had too much priority as measures for achieving funding support. They have not resulted in better results.

Over the last 20 years, there has been only limited evidence of cancer survival rates catching up with international averages in other prosperous countries. Professor Sir Alex Markham, the founding chief executive of Cancer Research UK, has observed that

“comparable health services abroad continue to outperform the NHS in terms of cancer survival. They all remain focused on cancer outcomes and the UK would be foolish not to do likewise”.

This clause should put that right.

When it comes to treatment after diagnosis, I understand that the NHS largely performs as well as other comparable health services. However—this is the important thing—it is not as good at catching cancers in their crucial earlier stages. If the new commissioning bodies under the Bill have to focus on outcomes, they will monitor survival from date of diagnosis. They will have to collect that data, identify dates of diagnosis and match outcomes. This will show which places are doing better than others. Researchers can then establish what the more successful places do and how they differ from the less successful ones. That way, routes to success may be identified. Improvements can and should follow. That is true evidence-based medicine.

Hitherto, data collection and data transparency have not been a strength. As Bowel Cancer UK told the APPG on Cancer, the priority should be to

“improve the quality and use of data”

produced. Indeed. Another point is that data on the less common cancers are not used consistently throughout the NHS. The focus to date has been on the so-called big four: breast cancer, prostate cancer, bowel cancer and lung cancer. Yet it is a fact that the other less common cancers, taken as a whole, constitute more than 50% of cancer cases in England at any one time.

The new statutory obligation addressing outcomes for all cancer treatment would ensure that such data are collected across the range of different cancers. This new provision will provide the springboard for long-overdue improvement in cancer detection and cure. I commend it to the House.