(2Â weeks, 3Â days ago)
Commons Chamber
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I thank the hon. Member for giving way and the tone in which she is conducting this debate. Would she feel more comfortable, however, if a transgender man with balding hair and a full beard, who was behaving like a man and full of testosterone, was attending a female toilet facility at night at a motorway service station? I would not feel safe, but it seems she would feel safer in that situation than she would with a trans woman getting changed in front of nurses or attending a toilet.
I am not sure why the hon. Member has reached that conclusion. I am saying that this is based on biology, and people who are trans require the same protections as people who are not—that is what I have said very clearly.
The Darlington nurses were particularly brave in bringing their case forward. The cost was ÂŁ187,000 in damages after an employment tribunal ruled in favour of them. That is a victory for dignity, for women and for common sense, but it is also a significant cost of public money to an NHS trust because it decided not to follow the law. That money could have been spent on patient care. What steps is the Minister taking to ensure that this guidance is fully and properly implemented across the NHS? How will she ensure that a repeat of the Darlington nurses case does not happen again, and what guidance has been given to NHS managers on how to handle this?
The Minister for Women and Equalities did not help matters. She had the responsibility to sign off the Equality and Human Rights Commission’s draft code of practice to inform businesses, services and public bodies how to implement the Supreme Court’s guidance in law. But for over a year, the Government failed to lift a finger to enforce the law. For over a year, businesses, hospitals, service providers and public bodies were left waiting for the Government to tell them what the official guidance said. Now that it is here, we need to know how it is being implemented. How will the Minister ensure that this guidance is implemented universally in our NHS? How will the Government ensure that single-sex spaces are protected? What provision will they make for transgender individuals? What reassurance can the Minister give to women working in our NHS that they are safe? Our new clause 143 makes it clear that both staff and patients in the NHS must have access to single-sex spaces to protect their dignity and their privacy. I hope the Minister will be able to support this; I cannot see why she would not.
The Government have also decided to abolish Healthwatch and reduce the number of local Healthwatch branches. Healthwatch England has been engaging with patients since 2013, with more than 150 operating in a hub-and-spoke model, but that is about to change. Why? One reason seems to be to avoid duplication. The Government are clearly not keen on lots of Healthwatch branches doing the same thing in different areas of the country and feel that some branches may operate better than others. They say that they want to bring feedback closer to decision makers, but is that a good idea?
The Government could have chosen to improve Healthwatch as it stands. In 2023-24, more than 925,000 people used Healthwatch to get advice and information, and more than 300,000 shared their experiences to improve services. They could have increased awareness further and developed a clear feedback chain, but instead they have decided to abolish Healthwatch altogether. That is of grave concern. How can patients be expected to complain to the system about the system? The Prime Minister previously wrote:
“People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.”
On that, he was right, and I ask the Minister to accept our amendment on this subject.
We have tabled a number of other amendments, including one on fracture liaison services, one that would produce a modern service framework for musculoskeletal care and others on radiotherapy, respiratory health, brain injury and the Government’s new medical devices regulations. However, I appreciate that we are short of time, so I will just make two short comments, if I may, Madam Deputy Speaker,
First, I of course agree with the intent of the Liberal Democrats’ amendment 140, but it requires the presence of HSSIB, and since the Government seem hellbent on removing that, I do not know how the amendment would work. New clause 81, a Back-Bench amendment that has been selected by Mr Speaker, relates to another really important issue. As a paediatrician, I see the importance of what it suggests. The regulations would need to be carefully drafted for those who have a brief illness, to define life-threatening illness more clearly and to avoid duplication of work, but in principle, it is an important amendment. I commend our amendments to the House.
I thank my hon. Friend for her best wishes and commend the work that she and many other Members are doing directly with their trusts to understand the impact of the work that we are doing to bring down those waiting lists and improve access for patients. As I have said, corridor care is a sign of systemic failure in the system and is unacceptable. I think we have all witnessed it in our local trusts, but it is coming down in places, and we want to continue to see it eradicated.
I pay tribute to my hon. Friend the Member for North East Hertfordshire (Chris Hinchliff) for his championing of the families of children suffering from life-threatening illnesses. I know that Members on both sides of the House recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their family. It is vital that all these families feel supported, informed and cared for, and I wholeheartedly recognise that the support that they are offered now is often not proactive or joined up, with the onus, as he said, being on families to navigate the system and seek support themselves.
With that in mind, the Government commissioned a report on the mental health impacts of life-threatening childhood illness on families, named in the memory of Hugh Menai-Davis. I pay tribute to Hugh’s parents for their campaigning and offer them my deepest condolences.
The report process is progressing well, and I can commit to the report being published in this Parliament, with a full Government response issued within three months of publication. For too long, children’s health has not been a priority, which is why my right hon. Friend the Secretary of State for Health and Social Care has directed the Department to make maternal and child health central to its work. We know that a child’s health has ramifications for the wellbeing of the whole family, and there must be better solutions to join up support for parents of unwell children.
The new cross-Government mental health strategy will also address how we better support parents and families, and the Government intend to work closely with parents, families and campaigners to identify workable solutions and make available more proactive support.
I turn now to the Opposition amendments, starting with new clause 142, in the name of the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson).
I will carry on.
As the hon. Member for Sleaford and North Hykeham knows well, provisions are already in place to appropriately control access to puberty-suppressing hormones for children and young people presenting with gender incongruence or dysphoria. Children and young people with gender incongruence deserve evidence-based care. The Cass review recommended a clinical trial to provide high-quality comparative evidence on the potential benefits and risks of the medicines. That is now under way.
I agree with the comments from the hon. Member for North Shropshire, but I have to disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, access to these types of medicines must be subject to the scrutiny and approval of Parliament. I think that, as a clinician, she understands that.
I would also like to address new clause 143. As the hon. Member for Sleaford and North Hykeham knows, the EHRC’s updated code of practice for services, public functions and associations commenced on 5 August. It provides guidance on how sex-based distinctions in the Equality Act can be applied, including in the NHS. This new clause is unnecessary. This legislation is the law and the law is clear. The NHS will obviously follow the law. New guidance has been drafted and will be published imminently. For the record, I am due next week to meet the Darlington nurses who she spoke for. I agree that they were brave; they should not have had to go through what they went through.
I want to address new clauses 41 and 42 on funeral regulation in the name of the hon. Member for Gosport (Dame Caroline Dinenage), who spoke powerfully on behalf of the whole House; I commend the work that she has done. My hon. Friend the Member for Kingston upon Hull West and Haltemprice (Emma Hardy) has spoken to me in great detail about this issue, as has my hon. Friend the Member for Leeds South West and Morley (Mark Sewards).
The Government were appalled by the offences committed by Robert Bush and the profound harm caused to bereaved families. Every deceased person must be treated with care, respect and dignity. We are undertaking urgent work to develop comprehensive proposals, including formal regulation of the funeral sector to drive out rogue operators and strengthen protection for bereaved families. As the hon. Member for Gosport said, operators that work well will also want to see this. We will begin sharing proposals shortly, and I am very happy to include hon. Members in the discussions.
Absolutely, and I am committed to working with my hon. Friend and many other hon. Members across the House.
I was pleased to meet my hon. Friend the Member for Manchester Withington (Jeff Smith) to discuss his amendments concerning medicines. I hope that I reassured him—from his speech, I think that I did—that the Government do support well-designed research into innovative treatments using controlled drugs, where this is conducted safely and appropriately. We also understand the complexities involved, including the need to minimise the risk of harm and misuse. That is why we are working across government to consider how to implement the recommendations from the Advisory Council on the Misuse of Drugs to reduce barriers to research with schedule 1 controlled drugs. I committed to write to my hon. Friend to set that out further; I will do.
A number of hon. Members tabled amendments on issues with their local infrastructure. We have already published the capital plan and improved long-term capital planning to improve local infrastructure.
I think that I have addressed most things—
I am so sorry; I will to talk to my hon. Friend later. The debate has been wide ranging. If there are things that I have missed, I commit to getting back to hon. Members. I know that my noble Friend Baroness Merron is committed to working co-operatively with all Members as the Bill proceeds through the other House.
(2Â weeks, 4Â days ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
It is a pleasure to serve under your chairmanship, Mr Pritchard. I give credit to all Members, who have participated in this difficult and sensitive debate in a thoughtful and constructive manner, and particularly to my hon. Friend the Member for Lichfield (Dave Robertson) for leading it. I thank Adam and Jamie for starting the petition and the more than 113,000 people who signed it. Many of my constituents asked me to attend the debate today, and I am proud to do so to stand up for families created through surrogacy.
When Adam and Jamie’s daughter was born, they became her dads the moment they held her. They had chosen to become parents and had prepared for their daughter’s arrival. They had so much love to give her, but the law did not recognise them as her parents. Often parents have to go to court to prove that they are the parents of the child they are already loving and caring for. That is just not right for the parents, for the surrogates and, more importantly, for the children, and it does not reflect the reality of the families involved. It creates unnecessary stress and anguish at an already difficult time when people are raising a newborn child.
To suggest that the concept of consent can be questioned after consent has been given is dangerous. No surrogate mother enters into this relationship lightly. It is something that women consider very carefully. I have spoken to friends who would happily be surrogate mums for other families to enable them to have children, because they enjoyed the experience of pregnancy. They would be happy to help in that way, but they would consent to that in the knowledge that they would not be that child’s mum. They would expect that child to have another mother, or mothers, or other fathers. That is the basis on which they give their consent.
To take the concept of consent in legal arguments, when people make wills—they might be vulnerable people or, much of the time, elderly people—there are always questions about whether they were put under undue influence, but there are legal mechanisms to check that that was not the case. Similarly, there are mechanisms to check whether a woman has given consent for sexual intercourse. We need to strengthen checks for consent in surrogacy relationships, but we cannot have a situation where somebody can give consent, which has been adequately checked and monitored, and then withdraw it afterwards. We have to be careful about challenging that, because it goes to the very root of consent, and it is dangerous to do so.
Rachel Taylor
I would like to make some progress, and the hon. Lady has made a number of points in her own speech and in other interventions.
Same-sex couples, disabled mums or mums who simply cannot have children have gone through an incredibly demanding process to start a family, and their family is treated differently from the moment their child is born. They can be left in limbo for months while social workers carry out assessments and family courts, with already massively long delays, consider their application for a parental order. That leaves them in limbo if their child is ill, taken into hospital, starts nursery school, or any number of things. Meanwhile, they are changing nappies, comforting their baby through all the sleepless nights and making every decision about their care.
Families should not be penalised because of the gender or sexuality of the people who love and raise that child. Our surrogacy laws are more than 40 years old. Families have changed and society has changed; the law must now change too. That is why the Law Commission’s proposals are so important. They set out a new pathway through which intended parents could be recognised as legal parents from birth, rather than waiting for months to obtain a parental order.
The work has been done, the evidence has been gathered and a draft Bill has already been produced. Will the Minister listen to the families who have shared their experiences, publish the Government’s full response to the Law Commission’s report and set out a clear timetable for reform? Adam and Jamie became dads the moment they held their daughter. It is time the law recognised that reality.
(5Â months ago)
Commons Chamber
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I do not think that anyone could have better described the importance of AHPs than my hon. Friend the Member for North Durham (Luke Akehurst). I pay tribute to my hon. Friend the Member for Dudley (Sonia Kumar) for securing the debate and for her tireless work as a physiotherapist; to my hon. Friend the Member for Thurrock (Jen Craft) for leading the debate; and to my hon. Friend the Member for Stourbridge (Cat Eccles) for all her work as an operating department practitioner—a profession that is often overlooked.
Allied health professionals are such an important part of our healthcare workforce, yet they are undervalued and poorly represented in NHS hierarchies. I am incredibly proud of the Government’s achievements within the NHS, including the £29 billion of additional funding—the largest injection of cash into our health service since Labour was last in government—a 320,000 fall in waiting list numbers, 5 million more NHS appointments, and the recruitment of 2,500 new GPs.
In my constituency, we have started to see the benefits of that investment for local people. George Eliot hospital has eliminated corridor care despite a difficult winter. It has also seen a 5% improvement in waiting lists. GP surgeries in Polesworth, Bedworth, Coleshill and Keresley are all getting upgrades, so that more patients can see physiotherapists, occupational therapists and other professionals much closer to home. There is much more to do, of course, but we should be proud of the progress we have made in less than two years.
These improvements would not have happened without the support of allied health professionals. Their workforce represents over 276,000 practitioners, aided by skilled support workers. The Government are right to be ambitious in their target to deliver more care in the community and invest in neighbourhood health centres across the country. To do that, we will rely on allied health professionals to support patients. We must embed dietitians, occupational therapists, osteopaths and physiotherapists into neighbourhood health if we are to succeed in treating more people closer to home.
I commend the work done on frailty by the Hazelwood group practice in Coleshill as part of the Apollo primary care network. I also pay tribute to the work of paramedics, radiographers and physios. My constituency is semi-rural and without a hospital, so the quick work of paramedics is crucial in providing urgent initial care and supporting my constituents on their journey to hospital.
Radiographers are vital in supporting patients through early diagnosis, as I found out myself a couple of weeks ago. Some 80% of hospital pathways require their skills for imaging to support a diagnosis. As part of this Government’s plans to bring care into the community, we must ensure that more radiographers are in community diagnostic centres like the one recently opened at the George Eliot hospital in Nuneaton or available through mobile services, to reduce pressure on hospitals. That way, patients can be treated faster and closer to home. On their behalf, I would like to ask the Minister to keep the chief allied health professions officer post in the Department of Health and Social Care and work with local ICBs to establish AHP director roles that have parity with medical directors and directors of nursing.
In 2018 my father had a stroke. The staff at George Eliot hospital were wonderful and took really good care of him. I cannot thank them enough for the support they gave him, but there reached a point when I was wondering, why is my elderly father still stuck in hospital? Why can he not leave, so that we can help him get better from the comfort of his own home and my elderly mum does not have to travel 10 miles each day to see him? What is the plan for him and other stroke patients after they leave hospital?
My dad, like many people recovering from a stroke, could not get the same support from speech and language therapy services at home or in his neighbourhood. Those are vital services that help patients learn to swallow and slowly regain their ability to speak and be understood. So my dad had to stay in hospital. He is definitely a fighter, and he regained his speech and his ability to sing in a choir. Patients like him deserve to be able to see speech and language therapists in their local neighbourhood, so that they can recover at home once they are medically fit to leave hospital.
This is not about freeing up spaces in hospital; it is about giving patients choice and the best care we can, so that they can recover comfortably at home, surrounded by friends and family. I will continue to work with all allied health professionals and their representative bodies to ensure that they are a core part of this Government’s 10-year health plan.
Finally, as a tennis player, I would like to thank the thousands of independent physiotherapists, support workers and students working in local gyms, on the high street, in professional sports facilities and at matches at weekends. Their support is vital to ensure that people can continue to play sport as they get older and that an injury does not stop them getting back on the court. We promised to deliver healthcare in the community, and with the support of allied health professionals, I am confident we will be able to do so successfully.
(5Â months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I thank my hon. Friend for securing this important debate. I was diagnosed with pre-osteoporosis when I suffered a minor injury from playing tennis, so for the last eight years I have been taking Adcal tablets regularly. I was proud recently to welcome a new state-of-the-art physical activity hub in Bedworth in my constituency, which will help residents to stay active and stop the symptoms of conditions such as osteoporosis. I would therefore like the Minister to address how the Government will make better use of our growing physiotherapy workforce—
Order. The debate may now continue until 4.55 pm.
Rachel Taylor
As someone who is taking medication to ward off the progression of osteoporosis, I was delighted to welcome Bedford’s new state-of-the-art physical activity hub, which will help residents to stay active and stop their osteoporosis developing. I would like the Minister to explain how the Government will make better use of the growing physiotherapy workforce to deliver early intervention, fracture prevention and rehabilitation in the community in places such as the Bedford physical activity hub.
Sonia Kumar
If someone says physio, I am always going to say, “Yes, yes, yes,” behind them. I agree with my hon. Friend that we should roll out physiotherapists and the multidisciplinary teams required to help those with osteoporosis. I also thank her for highlighting the importance of taking bone-sparing medication. Many people in the UK do not take it because they do not understand its importance.
More than 3.2 million people in England now live with osteoporosis, including just over 2.5 million women. One in two women over 50 will suffer a fracture caused by osteoporosis, as will one in five men. In terms of years lost to premature mortality and disability, those fractures are the fourth most consequential medical condition in the country. At any given time, around 7% of NHS beds are occupied by patients with fragility fractures, many of them because early warning signs were missed and opportunities to intervene were lost. Behind those figures are lives changed in an instant.
It is not just older people. One young woman told me:
“I thought my bones were something I wouldn’t have to think about until I was much older”,
only to find herself dealing with low bone density in her twenties after medical treatment. Some risk factors for osteoporosis include smoking, alcohol misuse, previous fragility fractures, low body mass index and long-term steroid use. Every single one of those factors needs to be looked after. We cannot look at osteoporosis as a one-condition problem; we must look at the whole lifestyle.
Through the work of the all-party parliamentary group on osteoporosis and bone health, which I chair, I heard from patients whose stories are not easily forgotten. A woman in her early sixties fractured her wrist after a minor fall. She was treated and discharged, but no one joined the dots. Within two years, she had suffered multiple further fractures, including to her spine. She now lives with constant pain from repeated spinal fractures, affecting everything from how she breathes to how she moves.
I think of those who never recover their independence —of people who go into hospital with a hip fracture and never come home. For many, that fracture marks the beginning of the end, with over a quarter dying within one year. What unites these stories is not bad luck, and they are not isolated tragedies. They are systemic failures: a missed referral, an overlooked warning sign, treatment not initiated, and a second fracture that should not have happened. That is why it is essential that, after a first fracture, every patient is identified, assessed and supported on to an appropriate treatment plan. One fracture must not become many.
Too often, the fall that brings someone into hospital is treated as a single event, rather than as an accumulation of undiagnosed and untreated conditions. We therefore miss the opportunity to change the course of someone’s life. Through the work of the APPG on osteoporosis and bone health, I have also seen stark variations in access to treatment across the country. Prescribing rates for critical second-line therapy are three and a half times higher in areas where GPs can prescribe it freely compared with areas where there is a need for specialist referral. A report has also found that GPs in more affluent areas are much more likely to be able to prescribe freely than their counterparts in the most deprived areas.
For people in many parts of the country, the barriers do not stop at the prescription pad. When shared care arrangements are not in place and GPs cannot prescribe, patients must attend hospital for routine injections that could be delivered safely in the community. As the Government develop the neighbourhood health service, there is a real opportunity for a multidisciplinary team approach to bone health, one that includes at its heart our allied health professionals, including physiotherapists, dieticians, occupational therapists, falls teams, consultants and advanced practice clinicians. Prevention, prevention, prevention is the key. The importance of a holistic approach is essential to prevention for those who may be susceptible to poor bone health. We should help those people lead healthier lives by stopping smoking, reducing alcohol intake and increasing exercise.
Talking of prevention, I need to welcome the Government’s commitment to fracture liaison services, which are the gold standard for fracture care and play an important role in identifying, assessing and treating osteoporosis in people over the age of 50 with a fracture. FLSs reduce fracture rates by up to 40%, and will prevent 74,000 fractures over five years, including 31,000 hip fractures. FLSs are also incredible value for money, breaking even within 18 to 24 months, with a return on investment over five years of £1.88 for every £1. Preventable osteoporotic fractures contribute to 1.5 million days off sick, costing employers £142 million in sick pay.
I also welcome the new DEXA—dual energy X-ray absorptiometry—scanners that the Minister’s Department has delivered, and the Government’s commitment to ending the postcode lottery for fracture prevention services. The Minister understands the scale of what is at stake. This must be only the start of managing osteoporosis and bone health.
Looking ahead, we know that the challenges will grow. By 2047, an estimated 4 million people in England will be living with osteoporosis, an increase of more than 700,000 on today’s figures. We know the scale of the problem, we know the treatments, and we have the evidence. What we have lacked for too long is urgency. There has been clear progress, and the Minister deserves credit for that.
I have three recommendations for the Department. First, we should roll out fracture liaison services to all parts of England. We are a Labour Government, and reducing inequalities is in our blood. We pledged to end this postcode lottery by 2030, and it is crucial that we deliver that. Secondly, we should introduce questions about bone density and osteoporosis in the health check for over-40s. Such pre-emptive measures, including risk stratification, lifestyle advice and early intervention where appropriate, can help people to deal with these issues before they become too serious. Thirdly, we should introduce targeted case finding and proactive bone health management for those aged 70 and above, particularly those at high risk of falls. That should include timely access to DEXA scanning, community-based treatment pathways, and co-ordinated fall prevention to help reduce fractures and associated mortality.
Osteoporosis is not an unavoidable consequence of ageing. It is a condition that we can prevent, predict and treat, yet for too many and for too long the first sign —the fracture—is missed. We know what works and we have the tools. Under the 14 years of the previous Conservative Government, we were missing consistency, urgency and the willingness to act. If we get this right, prevent the first fracture and intervene decisively after it, and ensure equal access to care regardless of postcode, we will not only save the NHS significant cost, but preserve something far more valuable: people’s independence, dignity and quality of life.
I hope that the Minister will consider my three recommendations and meet me to discuss them further. Osteoporosis is not just a clinical issue; it is a test of whether our health system truly prioritises the long-term health of everyone across the United Kingdom, and not reactive, short-term measures.
(6Â months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
It is a pleasure to serve under your chairmanship, Mr Mundell. Over the past year, the public debate has become often heated and personal and, at times, deeply harmful. The rhetoric has consequences, and we in this House must take responsibility for the climate that we help to create.
The Cass review’s recommendations were so important, and among them was a clear call for carefully designed clinical trials to build the evidence base around puberty blockers. Those trials would allow clinicians, patients and families to make informed decisions grounded in robust data rather than speculation or ideology. Those who argued that puberty blockers should be restricted due to insufficient evidence are now opposing the very research that would provide that evidence. That does not suggest a commitment to scientific rigour; it suggests a shifting position driven by political ideology. I am not a clinician, and I do not pretend to be. On matters such as these, we must be guided by medical evidence.
Rachel Taylor
For the sake of time, I will not.
The need to be guided by evidence is precisely why the current situation is so troubling. It is concerning that the MHRA initially raised no objections to the trial when it was approved but has since changed that position. As Dr Cass made clear, no new evidence has been presented to justify that shift. That raises serious questions about the basis of the decision, and whether an independent regulator has buckled to pressure from a well-funded lobbying campaign. As a consequence, vital research is now at risk, and that matters. The trials are not an optional extra; they are the mechanism through which we build the evidence base that critics say is lacking.
Rachel Taylor
No, I am not giving way.
We cannot afford to sacrifice the future of vulnerable young people on the altar of ideology. The trials received ethical approval and were recommended by one of the country’s foremost experts in child health. It is vital that they go ahead so that we can build the evidence we need to support safe, effective healthcare for young trans people.
Sarah Pochin (Runcorn and Helsby) (Reform)
It is a pleasure to serve under your chairmanship, Mr Mundell. I am concerned about the motivation behind the trials. I went to the initial meeting hosted by the Secretary of State for Health and Social Care, where we met the panel of so-called experts, and came away with the impression that this was nothing more than a spine-chilling, state-sponsored experiment on our children, with no regard to safeguarding them.
In the main Chamber, I asked the Secretary of State to introduce statutory legislation to access the extensive data that is already available from Tavistock; yet again, I was not provided with an answer as to why he could not do that. I am concerned about the profile of the children being used. I asked at the initial meeting for a lower age limit, but I was refused. I asked whether the Government would consider not including vulnerable children, children in care, or children on drugs for anxiety or attention deficit hyperactivity disorder, but I was refused.
We have all talked about the long-term damage that seems to be ignored, but one of the most important things that has not really been covered is parental consent. We have heard that consent would be needed from only one parent, if a parent was present in a child’s life. This can cause irreversible damage to families. Last week, I hosted a roundtable about the indoctrination of our children in schools on this very subject, and I heard horrific stories from isolated parents whose children were lost to them because of brainwashing and the fantasy world they had been taught about at school.
Sarah Pochin
No, I will not.
Overall, we are creating a generation of lost, anxious young people who are confused about their identity, socially insecure and physically scarred.
Iqbal Mohamed (Dewsbury and Batley) (Ind)
It is a pleasure to serve under your chairship, Mr Mundell. This is a Government who have shown that they care for the safety and welfare of children. They supported the Online Safety Act 2023 to counteract harmful digital content and removed, albeit eventually, the punitive two-child benefit cap to reduce poverty. The Government have committed to halving violence against women and girls, and have banned the pre-watershed advertising of junk food on TV.
However, the trial flies in the face of the Government’s explicit mission to protect children from harm. It would expose children to severe and irreversible harm when viable, less harmful alternatives are available. Despite that, the Government are happy to permit a clinical trial that would give puberty blockers to 226 children. Research has shown that over 95% of children who start out on puberty blockers continue on to cross-sex hormones, while other research has shown that between 60% and 98% of children with gender dysphoria will outgrow that feeling and go on to live a normal, natural, healthy life in their born body.
Iqbal Mohamed
I am going to continue, given the lack of time.
The numbers are important. They mean that the Government are choosing to prioritise the interests of between five and 90 of the 226 children involved in the clinical trial at the expense of deliberately harming between 135 and 203 children, who will eventually come to terms with their birth sex. I ask the Minister, will the Government now confirm that the current pause—which I welcome and am grateful to the Government for—will remain in place unless and until all safety, ethical and scientific concerns are fully and transparently resolved?
Thank you, Mr Mundell.
Dr Cass also recommended that we take forward the data linkage study as part of the wider national research programme. The linkage study is not a clinical trial, and as such it will not in and of itself provide the type of evidence that can demonstrate cause and effect for any particular treatment. It is observational in nature, linking and analysing existing routinely collected data for adults who were referred as children to the Tavistock before it was decommissioned. The study requires no active patient participation; instead, it relies on an analysis of digital information held within health records and other databases.
Data linkage studies have faced difficulties that are a matter of public record, but since then there have been great efforts to improve the collaboration of the adult clinics and other organisations. Important final steps are currently being taken to enable the study to begin. We expect the study analysis to then take around one year to complete. On 26 February, we laid an order before the House to make it lawful for people and organisations to share or process data that could be subject to protections under the Gender Recognition Act 2004 where it is for the purpose of the study. That order came into force last week.
The PATHWAYS clinical trial is a key step that we are taking to build an evidence base to prove whether puberty blockers are safe and effective in treating gender incongruence and gender dysphoria. As we speak, the new clinical model is collecting a consistent and comprehensive core clinical dataset while we develop a supporting national registry.
In the meantime, hormone medications are not being prescribed. NHS England now prevents the routine use of puberty-suppressing hormones in the NHS children and young people’s gender services, and the Government have indefinitely extended restrictions that prevent them being supplied privately. Last year, NHS England issued guidance to GPs that strongly advised against supporting prescribing agreements with unregulated providers, who do not always have children’s best interests at heart. That includes online overseas providers who are known to have supplied puberty suppressants and cross-sex hormones to children in the past without any proper safeguarding. NHS England issued that warning because of the serious safety risks that unregulated providers continue to pose to children in this country. In some cases, we are talking about puberty blockers being prescribed following a questionnaire or a brief Zoom call.
I will come on to other issues around future services, although I think I have answered most questions. All clinical trials have appropriate insurance to cope with the issues outlined by the right hon. Member for Tonbridge (Tom Tugendhat). The trial sponsor is King’s College, so my understanding is that the issue raised by the hon. Member for South West Devon (Rebecca Smith) with regard to the state having conflicts does not arise. The hon. Member for Bristol Central (Carla Denyer) cited regulations that were mainly from overseas, but the UK has its own regulatory independent network: the MHRA, which we work with. The Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), who I respect in her role as a paediatrician, asked a number of questions about timing and process. She will be aware that there is a judicial review, but I will make sure that she gets an answer on some of those issues.
I want to update the House that since April 2024, NHS England has opened three new services in the north-west, London and the south-west. I can confirm that a fourth service will become operational at Cambridge University hospitals NHS foundation trust very shortly. Those are important services for young people and their families who are awaiting treatment and who want to understand when and how they will receive care.
I am not going to give way.
Those services operate under a fundamentally different clinical model from the Tavistock clinic. Children and young people will get comprehensive, tailored assessment and support from multidisciplinary teams made up of experts in paediatrics, neurodiversity and mental health.
Under this Government, mental health spending has gone up in real terms, and we are putting specialist mental health teams in every school to support those young people. However, I know there are still families who are desperately worried by some of the debate and are concerned about the future, often to the detriment of their own mental health. They want clarity on the options open to them. I want to end by assuring hon. Members that we will update the House on all these issues as soon as possible. I urge all hon. Members to continue to engage with the evidence that best supports our young people. That is what we, as a Government, continue to be focused on.
(8Â months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The example of the hon. Member’s ICB is typical of ICBs around the country. The purpose of this debate is to raise the issue with the Minister and highlight how important it is to improve diagnosis and speed up how quickly people can get access to treatment and medication.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I thank my hon. Friend for securing this really important debate. Last year, a number of constituents contacted me because they were similarly concerned that Coventry and Warwickshire ICB decided to pause new ADHD referrals for those 25 and over so that it could prioritise children on its waiting list, which was at a really critical point. I recently met the chief executive of the ICB, who confirmed that referrals for adults will restart in May. Does my hon. Friend agree that we must get the balance right so that children and adults with ADHD get the diagnosis and support that they so desperately need?
It is good news that we are seeing some progress in my hon. Friend’s ICB. I profoundly hope that NHS staff in other ICBs around the country are watching this debate and will follow the lead of her ICB in improving the access that is needed.
(8Â months, 2Â weeks ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
It is a pleasure to serve under your chairmanship, Mr Efford. I thank the hon. Member for Wokingham (Clive Jones) for securing this debate. I pay tribute to my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton) for all the valuable work she does in this space, and to everyone who has shared very personal stories today, particularly my hon. Friend the Member for Southport (Patrick Hurley).
Pancreatic cancer is one of the least survivable cancers. Sadly, a number of constituents have written to me about the devastating impact this disease has had on their lives. One lost her stepmother to pancreatic cancer. For months, her stepmother’s symptoms were repeatedly misdiagnosed—she was even sent home from A&E on several occasions with painkillers or antibiotics—before she was finally diagnosed with stage 4 pancreatic cancer. She died just three months later, only three days after my constituent’s son was born. My constituent told me that she feels her son was robbed of a grandma.
Similarly, Jacqui wrote to tell me about the close friend she lost to pancreatic cancer and the profound effect it has had on her. Tracey, Irene and Janice also wrote to tell me about the loved ones they have tragically lost, and to advocate for better research and treatment for this cruel cancer. Each story is different, but every constituent who has written to me about pancreatic cancer has called for improved screening, earlier diagnosis and greater investment in research.
Kelly and Jennifer both wrote to me while a loved one was undergoing treatment for pancreatic cancer and was forced to deal with shortages of the medication they desperately needed. It is unacceptable that patients and their families must tackle medicine shortages on top of battling cancer.
I truly believe that this Government’s 10-year health plan will support patients fighting less survivable cancers by ensuring that they have access to new treatments and technologies that can diagnose cancer earlier. We must ensure that these cancers are detected sooner and treated more effectively, so that fewer families endure the heartbreak of supporting a loved one with a less survivable cancer. Also, as the Minister has done so well, we must continue to speak out so that people become more aware of symptoms early and seek help and diagnosis.
In my remaining seconds, I pay tribute to my local hospice, the Mary Ann Evans hospice, which provides care at home for many people across my constituency and neighbouring constituencies.
I want Mr Jones to have a couple of minutes at the end, which means the Front Benchers have about eight minutes each.
(9Â months, 1Â week ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
We are only at the start of this urgent question, so I ask Members to reduce the temperature in the Chamber.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I thank my right hon. Friend for the care and sensitivity he has taken to this subject all along. It has been an undeniably difficult year for transgender people in Britain. I have spoken to young trans people who have been pushed to the brink of suicide by what they hear—that they do not have a right to exist, that they do not deserve rights, that they are legitimate targets for ridicule. We all in this House have a responsibility to lower the temperature and focus on their welfare, health and dignity.
King’s College operates the highest standards of safety. Does the Secretary of State agree that its expertise and rigour will support the wellbeing of participants and ensure that we get the robust evidence we need and that vulnerable children are no longer treated as political punchbags?
My hon. Friend is absolutely right that we must engage with due care and sensitivity on this issue. I can share with the House that these exchanges, Government policy, what is said by me and others, are followed extremely closely by this group of children and young people, who are extremely online, and by the wider LGBT+ community. My hon. Friend is right that trans people are often at the wrong end of the statistics as victims of hate crime, discrimination and mental ill health. We must always tread carefully when talking about suicide in this context, and bear in mind the warnings of the Government’s adviser on suicide prevention, Professor Louis Appleby, and the way in which that issue has been deployed irresponsibly by critics of the ban on puberty blockers that was put in place—we bear all those things in mind. I do think we have a high-quality trial set up. I do have confidence in the clinicians. We have had a cross-party briefing from the clinical team. I am happy to repeat that exercise, to keep coming back to the House and to arrange briefings for MPs and peers on a cross-party basis so that we can follow this closely, as we should.
(9Â months, 1Â week ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I beg to move,
That this House has considered the provision of healthcare for transgender people.
It is a pleasure to serve under your chairmanship, Mr Turner. This debate is about healthcare for trans adults. I know that a lot has been said in this House in recent weeks about care for young people questioning their gender identity, and particularly about the recent announcement of a trial of puberty blockers. I do not wish to repeat that debate here, other than to say that I welcome the fact that the trial is going ahead to ensure we can get the evidence that we need.
I want to begin with the experience of one of my constituents, because this debate must be about real people, not headlines in The Times or the Daily Mail, not culture war soundbites, not the opinions of Donald Trump or J. K. Rowling, and certainly not whatever bile is being pushed out by transphobic trolls on social media. This is about real people’s lives.
Earlier this year, my constituent, a trans woman, came to my surgery to share her experience of accessing healthcare locally. At her GP practice, she was told that she could not use the women’s toilets and must use the men’s instead, and she was repeatedly misgendered by staff. She faced difficulties simply getting her preferred name recorded correctly. On one occasion she was even told that she could not wait in the waiting room because she “scared other patients.”
My constituent is also struggling to access the gender-affirming care that she needs. There are no adult gender services in Birmingham, let alone in my constituency of North Warwickshire and Bedworth, meaning that she would have to travel to Nottingham for treatment. She is stuck on a waiting list with no idea when she will finally receive care. Because she cannot get NHS support, she is taking hormone replacement therapy on a private prescription and is understandably anxious about dosage and the lack of monitoring or regulation. She is not alone.
Emily Darlington (Milton Keynes Central) (Lab)
My hon. Friend is making a powerful speech and bringing the debate back to people, which is where it needs to be. I want to highlight a case in my constituency of a young transgender person who spent two years on the under-18s waiting list for an initial appointment. They have now aged out of that waiting list and potentially have a six-year wait, meaning that when they are able to speak to a doctor or a health professional it will have been eight years. Their parents approached me to tell me how much that is damaging their young one.
Order. I remind Members that interventions need to be very short. Lots of Members want to take part in this debate and long interventions eat into the time for speeches.
Rachel Taylor
I thank my hon. Friend for sharing that experience. It reflects the reality for many trans young people and adults in the UK: discrimination from healthcare professionals, waiting lists stretching over years, a complete lack of local provision and a reliance on less well-regulated private providers. That is the state of healthcare for trans people in Britain today. It is woeful and inadequate, and it is letting people down.
The consequences are serious. Almost one in four transgender people avoid going to the doctor altogether for fear of mistreatment. They delay cancer screenings and push aside chronic pain, and their health outcomes worsen as a result.
Rebecca Smith (South West Devon) (Con)
The NHS has finally issued a call for evidence regarding a clinical pathway for adults who wish to detransition. Does the hon. Lady agree that that is a welcome and long-overdue first step, and that the NHS must continue making serious efforts to improve care for detransitioners?
Rachel Taylor
As I welcome services for trans people, I also welcome services for those people who do not feel happy in the gender that they have acquired. That is only right, but we have to get all those services right.
Trans people are now seeing their health outcomes worsen. Waiting times for gender-affirming healthcare are nothing short of a national scandal. Across the UK as of March 2025, more than 48,000 trans adults remained on waiting lists for that care. We rightly debate NHS waiting lists in this place: a year for a hip replacement; months for cancer screening. Nobody finds those waits acceptable, but freedom of information requests reveal that the average wait for gender services is 12 years in England, two years in Wales, 41 years in Northern Ireland and a staggering 58 years in Scotland. At one Scottish clinic, the wait was three times longer than the average British life expectancy.
Graeme Downie (Dunfermline and Dollar) (Lab)
I thank my hon. Friend for highlighting the waits that transgender people face in Scotland, which are far too long. I recently met a group from the transgender community in Dunfermline who are concerned about their safety when they are out on the streets, whether going out on a Saturday night or doing anything else that they would like to. Does my hon. Friend agree that we must work with the police across the UK to make sure that transgender people feel safe on the streets?
Rachel Taylor
My hon. Friend is absolutely right. Trans people are fearing for their lives in my constituency, in his constituency and in many others up and down this country.
Let us imagine being told that the wait for a hip replacement or a cancer check was 224 years—it just would not happen. Some Members in this House might not want to hear it, but the reason that the NHS provides gender-affirming treatments—hormones, surgeries, and mental health and social support—is because they are proven to improve mental health, reduce gender dysphoria and significantly reduce depression, anxiety and suicidal thoughts.
Doing nothing is not a neutral act—doing nothing allows suffering to grow. The Women and Equalities Committee heard that directly earlier this year. To echo the findings of the Trevor Project’s 2024 report, LGBTQ+ young people’s suicides are preventable. Prevention means tackling discrimination, hostility and unaccepting environments. Safe, supportive, affirming care saves lives. One trans adult told the LGBT Foundation:
“The only effective treatment for gender dysphoria is transition and leaving this untreated is killing people.”
Rachel Taylor
I will make some progress, if I may. I am part-way through something that a trans person said, so it is not an appropriate time to intervene. They went on to say:
“I have personally used alcohol, cannabis, cocaine and self-harm to survive the last year and a half since referral and I have now been told I will have to wait several more months because of the backlog.”
I am reminded of last year when a mother came to me back home. Her son wanted to transition. The mother was under real pressure, as was the young boy. We tried to help as much as we could through the health system back in Northern Ireland. Does the hon. Lady agree that there is a journey not only for the young person who wants to transition, but for their parents? Everyone needs support to get them through that difficult transition.
Rachel Taylor
I thank the hon. Gentleman for his helpful contribution. Of course, parents need help and support through this process.
In 2022, a coroner ruled that a 20-year-old trans woman had died in part because of delays in accessing gender-affirming care after two and a half years on a waiting list. Trans people also struggle disproportionately with general healthcare. A third of trans and non-binary people, rising to almost half among people of colour, received no NHS or private support during pregnancy, compared with just 2.4% of cis women. Nearly one in three trans and non-binary birthing parents said that they were not treated with dignity and respect in labour, compared with just 2% of cis women.
According to TransActual, 60% of trans people surveyed had been refused care because they were trans. Hundreds reported that their GP refused to prescribe hormones, even when they had been recommended by NHS gender clinics. Participation in cervical screening is also significantly lower, with trans and non-binary people estimated to be up to 37% less likely to be up to date with appointments. This Labour Government are the right Government at the right time to tackle these issues.
I congratulate the Minister and the Secretary of State on the HIV action plan that was announced this month. I remember vividly the stigma and shame of an HIV diagnosis in the ’80s and ’90s, which often led to suicide, as the alternative was a death sentence and a life spent facing discrimination and abuse. This HIV strategy is groundbreaking and sets us on the right path to end new HIV transmissions. I applaud its commitment to ensuring that all prevention efforts target underserved populations, including trans people.
The Government pledged in their manifesto to ensure that trans people receive the healthcare and support they need. I welcome the review being led by Dr David Levy into adult gender services, and I hope it will bring forward strong recommendations to cut waiting lists, expand access and deliver timely, appropriate and sensitive care. I know that trans people and LGBT organisations have been awaiting its publication, so I ask the Minister: when can we expect Dr Levy’s review to be published?
In April 2025, the Secretary of State also commissioned NHS England to undertake an LGBT+ health evidence review. That review seeks to identify the barriers to healthcare for all LGBT+ people, from examining the poor treatment of lesbian couples seeking IVF treatment to looking at insufficient mental health support for LGBT+ people. The review is highly anticipated by the whole community. Therefore, I ask the Minister: is Dr Brady’s review still due to conclude in January 2026, and when can the public and parliamentarians expect to see it?
Although I applaud the Government’s work to improve healthcare for transgender adults, I know that reviews alone will not fix the problem. We need to know that these reviews will be followed by action. I know that getting this right matters to the Government, so I ask the Minister: what steps will the Government take to reduce discrimination and transphobia in healthcare settings?
Will the Minister commit to mandatory training for clinicians on the respectful and appropriate treatment of trans patients? Will the Government commit to significant sustained investment in trans healthcare, with reducing waiting lists and expanding local provision as urgent priorities? We must build a healthcare system rooted in science, not stigma, and in compassion, not fear. We must decide whether we want to be a society that listens to people, supports them and gives them the tools to thrive.
There is one final point I would like to make. Those who know me will know that I first got involved in politics in the 1980s when Thatcher was introducing section 28. That policy was intended to make people like me feel shame about who we were, and to reverse the progress that previous generations had fought for. I got into politics to fight that cruel law and everything that it represented.
I am a gay woman who grew up in the ’80s, so I know what it feels like to be told, “It’s just a phase. Maybe you’ll grow out of it. Maybe it’s not really who you are. Maybe there’s just something wrong with you,” so believe me when I say that I have heard it all before. LGBT people have heard this all before. We know what bigotry is when we see it, and we know that bigotry is back. Let us make no mistake: the people who are organising against trans people now are no different from the people who campaigned for section 28. They want to present parts of our movement as a danger to society and push them to the margins. I will never let that happen.
To all those in this room and in this House who are totally convinced that trans people are not real, that they are making it up, that it is TikTok, Reddit or foreign TV that has turned them trans, that somehow this is some kind of new phenomenon, let me assure you all that I have had trans friends for as long as I have been out. Trans people have always and will always exist.
To all those in this room who used to say warm things about trans people back when it was popular to do so but who decided when the wind changed that they would blow in the other direction, and to the Conservatives who in 2018 introduced an LGBT action plan promising trans equality but who now are quite happy to laugh along with cruel mocking jokes about trans people in front of the mother of a murdered trans teenager, we see you, and much like history condemns section 28, history will condemn you too. Meet trans people, talk to them, understand what they are going through and believe them, then we can all stop fighting our toxic culture wars and get back to doing what we as lawmakers are elected to do: make things better for every single one of our constituents—not some of them, all of them.
Rachel Taylor
I thank everyone who has spoken in this debate, and all my hon. Friends, for their passion, care, advocacy, understanding, kind words and leadership in this area. The tone of the debate has proved that we can, away from the glare of culture wars, have a sensitive and nuanced discussion about how to guarantee care for some of our most vulnerable citizens and how to support their families.
I thank the Liberal Democrat spokesperson, the hon. Member for Mid Dorset and North Poole (Vikki Slade), for her understanding and clarity of thought; she is a strong advocate. I also thank the spokesperson for the Green party, the hon. Member for Bristol Central (Carla Denyer).
I thank the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), for coming here divested of some of the toxic and inflammatory zeal, even though she seemed more concerned about the small number of people who are detransitioning rather than about all trans people and their healthcare.
Most of all, I thank the Minister for her remarks. I welcome her commitment to first-class healthcare for everyone. I welcome the Brady review reporting early in the new year, including the fact that there will be between seven and 12 healthcare centres for young trans people, with more clinics to come around the corner. I also very much welcome her Waiting Well pilot and hope that it can be rolled out across the country.
I want to finish by broadening out this discussion. This has not been an easy year for trans people. The Supreme Court judgment and the misguided, unnecessary interim guidance that followed from the Equality and Human Rights Commission have created genuine fear that rights long enjoyed are now at risk. We have heard today about the poor state of healthcare for trans people in this country, and flawed guidance risks making that situation worse.
I have heard from trans and non-binary people who have developed urinary tract infections because they feared going to the toilet. There is no doubt that the toxic culture wars have the potential—
(9Â months, 2Â weeks ago)
Commons ChamberMy hon. Friend is absolutely right. To be honest, the thing that causes me most anxiety is that, although I know that the NHS is on the road to recovery, we are surrounded by an enormous amount of jeopardy. We need, as much as we possibly can, to make sure that we are not inflicting avoidable damage or setbacks on our progress, and it feels like that is what this round of strike action represents. My hon. Friend is right to praise NHS leaders and managers. I know how emotionally invested they are in seeing their patients and their staff through this Christmas, and I urge resident doctors and the BMA to take up not only the deal but the opportunity to at least put off strike action to January.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I thank the Secretary of State for all his work on this matter so far, but I know that people in my constituency are going to be really worried about what might happen to them over the Christmas period. I thank all those hard-working NHS staff, be they nurses or doctors, who have continued to look after us and are facing a really difficult situation over this Christmas. Does my right hon. Friend agree that we need to urge the BMA to call off this strike and, in doing so, will he commit to continuing that dialogue with the profession so that it knows that he really understands the challenges it faces, the training opportunities it needs and the job opportunities it deserves?
I entirely agree with my hon. Friend. This is the point that I have impressed on the chair of the resident doctors committee. This deal is not the end of the conversation about jobs and career development in the NHS, because there are plenty of problems for us to solve. Although we cannot afford to go further on pay this year, what we have done so far—28.9%—is not the extent of what the Government can and are willing to do on pay. It just requires a bit of give and take, and I think we will make much more constructive and meaningful progress if we work together. I have my part to play in that, and from my point of view, we need to reset the relationship. It has hit the buffers somewhat in recent weeks. I am willing to do that. We have people we can work with on the resident doctors committee, but I think we are going to have to grasp the olive branch as it is presented today so that we can make more progress in the new year.