Conversion Practices (Prohibition) Bill

Tonia Antoniazzi Excerpts

2nd reading
Friday 1st March 2024 Commons Chamber

[Tonia Antoniazzi (Gower) (Lab)]

I would like to take this opportunity to thank my hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) for the extent of his engagement with those with varying perspectives on the Bill. We have crossed swords on occasion, but it is important that the conversation and debate in this Chamber is led with the honesty and integrity that it deserves.

No one wants to see pressure or coercion used on people, whether they be gay, lesbian, bisexual, transgender or heterosexual—I know that all Members of this House can agree on that. Working on the law as we do, however, we also know that best intentions alone are not sufficient to avoid unintended consequences, which can arise from any piece of legislation—we always see that in this place. Whatever the issue at hand, we have a responsibility here; as elected Members of Parliament, it is our job—it is precisely why we were voted into this place—to interrogate proposals, scrutinise legislation and ask the difficult questions, the “what ifs”, to ensure that any legislation that passes works in practice for the benefit of the people in this country, rather than against them.

Before I became an MP, I worked in education for 20 years, as a teacher. The majority of my friends are still in teaching and they have many concerns; they feel at first hand the chilling effect on them of the debate we are having in this House, as well as of what has happened in Scotland and what is happening in Wales. That is why I feel a great and deep responsibility to stand up here today, to have this debate and to raise the issues that I have with the Bill as it stands. However, I thank my hon. Friend for opening the conversation, because engaging is the way forward.

Young people and children are at the heart of everything I do, and I base my approach to this discussion on wellbeing and safeguarding. The matter of therapy and treatment for children and young people experiencing gender distress is a highly complex area, which is undergoing a review in the UK. Far from referring to sexual preferences or a way of life, gender reassignment concerns serious, potentially life-altering medical and surgical interventions that are often irreversible. In recent years, there has been a concerning increase in the number of children, particularly girls, becoming convinced that they were born into the wrong body. As someone who was a tomboy as a young girl, I know that, had I had some of these conversations, or had these social media influences on me, this would be something that I might have wished for.

Dr Hilary Cass’s interim report exposed the extent of the failings of the gender identity development service at the Tavistock clinic, criticising the “predominantly… affirmative, non-exploratory approach” and highlighting a disturbing lack of support for young people with gender dysphoria. The report, and the subsequent decision to close the GIDS at the Tavistock clinic, is evidence that treatment should be provided as part of holistic mental health provision. Accompanied by the consequent NHS interim service specification, it recommends a “watchful waiting” approach, advising that clinicians remain open to question and explore a gender-distressed child’s feelings and the range of available treatment options that may best address a patient’s needs before affirming their self-diagnosis. That is to ensure that if a young person does pursue medical transition, they do so with informed consent and a realistic understanding of likely outcomes.

If it follows the evidence, the future direction of treatment for children experiencing gender dysphoria should be psychotherapeutic and exploratory, but I have concerns that the Bill as drafted risks further impacting standards of care by threatening medical professionals and clinicians who use an exploratory approach. My hon. Friend the Member for Brighton, Kemptown has made efforts to reflect those concerns in the Bill, yet despite the exception in clause 1(2)(c) for health practitioners, its focus on “predetermined purpose and intent” still risks criminalising health professionals who engage in exploratory conversations with their patients. Legitimate clinical practice will sometimes have a predetermined outcome where a confident and clear diagnosis is made. Should a clinician have published research indicating a preference for psychotherapeutic approaches that could alleviate a child’s distressed alienation from their body so that they come to accept themselves as enough as they are, such research could be cited as evidence of predetermined intent of an outcome. The clinician would then be at risk of prosecution if he or she did anything other than affirm a child’s diagnosis.

What is more, the Bill does not require proof that any harm was intended or caused by the clinician’s conduct. It is highly irregular to criminalise motivations alone in the absence of demonstrably harmful behaviour. Professionals must be able to question and explore a gender-distressed child’s self-diagnosis without fear of prosecution, or even accusations of such behaviour. In recent years, countless clinicians have spoken of the flight of professionals working with young people experiencing gender incongruence. The interim Cass report highlighted that professionals already feel under pressure to take an unquestioning affirmative approach that is diametrically opposed to standard practice in all other clinical encounters. Fear of prosecution would exert further pressure on professionals working in an already sensitive and culturally fraught area, and would risk accelerating their departure from the field. My concern is that the Bill could leave unquestioning affirmative treatment as the only option.

[Miriam Cates]

The hon. Lady is giving a superb speech. I completely agree that clinicians are already under pressure to use an affirmative approach. Is one of the problems not that many of the professional bodies, including the NHS, have signed up to that approach, and therefore, even with the safeguards provided in the Bill, those therapists would be committing an offence if they took a predetermined course—let us say, to prevent a patient from going down a transgender route?

[Tonia Antoniazzi]

I thank the hon. Member for her question. That is what we need to be able to discuss and look at in further detail, and to thrash out in Committee. We need to ensure that clinicians, particularly those in the NHS—we need them to stay in their field—do not face a chilling effect. The risk of that chilling effect should not be understated: it could make the holistic therapy that is recognised as critical by the Cass review harder to access. Our priority absolutely has to be the legitimate and workable protection of the provision of good, evidenced care for children and young people.

I believe that the Bill should go to Committee. We need sunlight on it to make sure that, if it passes, it has been subjected to detailed consideration of its wording and an understanding of what those words mean for people on the ground, working in our NHS, teaching the children in our schools and working in safeguarding, and for parents, who are a priority.