Cass Review

Wes Streeting Excerpts

Monday 15th April 2024 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of her statement and, even more importantly, Dr Hilary Cass and her team for the thoughtful and thorough way in which they have undertaken their work. Dr Cass has navigated the complexities and sensitivities of the subject with academic rigour, providing an evidence-led framework for children to receive the best possible healthcare. I also pay tribute to journalists such as Hannah Barnes and the whistleblowers who together helped to shine a light on what was going on at the Tavistock clinic.

At the heart of the complexity around this issue are two things that are true simultaneously. There are trans adults in this country who have followed a medical pathway and who say that, for all the pain and difficulty that involved, it was not just life-affirming; it was lifesaving. There are also people in this country who followed a medical pathway but who say it was a disaster that ruined their lives irreversibly, and they ask how anyone could have let that happen. For the sake of all those children, young people and now adults—but particularly those being referred into gender identity services today—we have a duty to get this right.

What has emerged in the Cass review is a scandal. It is a scandal that children and young people are waiting far too long—often years—for care while their wellbeing deteriorates and their childhood slips away. It is scandalous that medical interventions have been made on the basis of shaky evidence. It is scandalous that, despite all that, some NHS providers refused to co-operate with Dr Cass’s review. Perhaps the worst scandal of all is that the toxicity of this discussion means that people have felt silenced, and it required investigative journalism to prompt the review to take place. This particularly vulnerable group of children and young people are at the wrong end of all the statistics for mental ill health, suicide and self-harm. There is no doubt that they have been very badly let down, so we owe it to them to approach this discussion with the same care and sensitivity with which Dr Cass undertook her review.

Parts of the report will sound familiar to anyone acquainted with the NHS today. Children and young people face unacceptably long waiting lists and are unable to get the mental health support and assessments they require, and services face significant staff shortages, with a lack of workforce planning driving all of that. As with so many parts of the NHS today, the report paints a picture of a service unable to cope with demand. Dr Cass is clear that care must be personal and holistic. Will the Secretary of State set out how she plans to cut waiting times for assessments for mental health and neurodevelopmental conditions?

Waiting lists are so bad in some cases that children are passing into adulthood before they have had their first appointment with gender identity services, leaving them facing a cliff edge. Cass recommends follow-through services up to the age of 25 to ensure continuity of care. Will the Secretary of State indicate how long she thinks it will take to establish those services?

Labour welcomed the decision by NHS England last month to stop the routine prescription of puberty blockers to under-18s. The loophole that exists for private providers risks sparking a black market. The Secretary of State has said that she expects private clinics to follow the report’s recommendations to follow the evidence. I underline our support for her expectations on compliance. Can she give an indication of whether she thinks that further regulation may be needed to ensure adequate enforcement of the recommendations?

The refusal of adult gender services to share data on the long-term experience of patients is inexcusable—as the Secretary of State said, it is deplorable. The data does not belong to them; it belongs to the NHS and, crucially, to patients. I welcome their coming forward now, but how was this allowed to happen, and what accountability does she think would be appropriate?

This report must provide a watershed moment for the NHS’s gender identity services. Children’s healthcare should always be led by evidence and be in the best interests of children’s welfare. Dr Cass’s report has provided the basis on which to go forward. The report must also provide a watershed moment for the way in which our society and our politics discuss this issue. There are children, young people and adults—including trans children, young people and adults—in this country who are desperately worried and frightened by the toxicity of this debate. There are healthcare professionals who are scared to do their job and make their views known. Dr Cass said that

“toxic, ideological and polarised public debate has made the work of the Review significantly harder”

and it will hamper the research that is essential to finding a way forward.

Even in a general election year, there is surely one issue on which we can down tools and work together: the pursuit of the healthcare of vulnerable people. I pay tribute to the right hon. Member for Bromsgrove (Sir Sajid Javid). We had many scraps across the Dispatch Box, but for his role in commissioning this review he deserves our thanks and respect. I hope to work constructively with the Health Secretary to put children’s health and wellbeing above the political fray.

[Victoria Atkins]

I welcome all those who have changed their minds about this critical issue. In order to move forward and get on with the vital work that Dr Cass recommends, we need more people to face up to the truth, no matter how uncomfortable that makes them feel. I hope the hon. Gentleman has the humility to understand that the ideology that he and his colleagues espoused was part of the problem. He talked about the culture and the toxicity of the debate. Does he understand the hurt that he caused to people when he told them to “just get over it”? Does he know that when he and his friends on the left spent the last decade crying, “Culture wars,” when legitimate concerns were raised created an atmosphere of intimidation, with the impact on the workforce that he rightly described? People were scared or worried to go into it.

Does the hon. Gentleman now have the good grace to apologise to those who have been maligned in public life—including his own female colleagues—and for the chilling effect that this has had on clinicians, journalists and campaigners who were trying to raise the alarm? I say that because I want to believe the hon. Gentleman when he says that he has turned a corner on this issue. We have to start with a new page, for the sake not just of the children and young people we are looking after but of their families, many of whom will be watching this, living with the consequences of the ideology and secrecy, wondering how on earth the hon. Gentleman talks about general elections when, every single minute and day, their children have to live with treatment that can never be reversed.