Puberty-suppressing Hormones

Wes Streeting Excerpts

Wednesday 11th December 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

With permission, Madam Deputy Speaker, I shall make a statement on puberty blockers.

At the outset, I wish to make clear the principles that drive the Government’s approach to this issue. First, children’s healthcare must always be led by evidence. Medicines prescribed to young people should always be proven to be safe and effective. Secondly, evidence-led, effective and safe healthcare must be provided to all who need it, when they need it. Thirdly, this Government believe in the dignity, worth and equality of every citizen, and recognise that trans people too often feel unsafe, unrecognised and unheard, and that must change. None of these simple ambitions has been achieved in recent years. Medicine has been provided with insufficient evidence, and young people have been left to go without the support and care that they need. This Government are determined to change that.

The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are safe or beneficial. That evidence should have been established before they were ever prescribed for that purpose. It is a scandal that medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial.

Following the Cass review, the NHS ceased the routine use of puberty blockers to treat gender incongruence in children. In May, the previous Government issued an emergency order to extend these restrictions to the private sector. In Opposition, my party and I, as shadow Health and Social Care Secretary, supported those decisions. Since coming into office, I have renewed this order twice, continuing restrictions until the end of this year. That was done jointly with the Health Minister in Northern Ireland, and I updated the House via a written statement.

While the temporary ban was in place, I asked the Commission on Human Medicines to look at the current environment for prescribing puberty blockers, and we launched a targeted consultation. The commission is an independent body, made up of leading clinicians and epidemiologists, that advises on medicine safety. It took evidence directly from clinical experts, consultant paediatric endocrinologists and patient representatives, including representatives of trans people, young people and their families. After thoroughly examining all the available evidence, it has concluded that prescribing puberty blockers to children for the purposes of treating gender dysphoria, in the current prescribing environment, represents “an unacceptable safety risk”. Of particular concern to the commission was whether these children and their families were provided with enough time and information to give their full and informed consent. The commission found that children had received prescriptions after filling out online questionnaires and having one brief Zoom call with prescribers from outside the UK.

Consequently, the commission has recommended that the Government extend the banning order indefinitely, until a safe prescribing environment can be established for these medicines. On the basis of those findings, I am acting on the commission’s advice and putting in place an indefinite order to restrict the sale or supply of puberty blockers to under-18s through a prescription issued by either a private UK prescriber, or a prescriber registered outside the UK. This is on the advice of expert clinicians, the independent Commission on Human Medicines—advice based on the best available evidence—and follows the cautionary and careful approach recommended by Dr Cass. The legislation will be updated today, and will be reviewed in 2027, when there will be an updated assessment of the safety of the prescribing environment for these medicines.

We are working to grow a thorough evidence base for puberty blockers. The National Institute for Health and Care Research is working closely with NHS England to establish a clinical trial on puberty-supressing hormones. The NIHR is now contracting the team that will deliver the study and is working tirelessly towards recruiting the first patients by spring. The trial is the first of its kind the world over. It will help us better understand the effects of puberty-suppressing hormones on young people, providing the robust evidence required.

The Cass review also made clear recommendations to the Government and NHS England on improving healthcare services for children with gender dysphoria. I will now provide an update on the progress made. NHS England has published its implementation plan, which will transform its services. It has also published a new services specification, to ensure that children and young people experiencing gender incongruence have an appointment with a paediatrician or mental health professional before being referred to specialist services. Dr Cass was clear on the need for the model of care to change and take account of children and young people’s holistic needs.

Since April, NHS England has opened three new gender identity services—in the north-west, in London and in Bristol—with a fourth expected in the east of England by the spring. That puts us on track to open services in every region by 2026. These services offer a fundamentally different clinical model. They bring together clinical experts in paediatrics, neurodiversity and mental health, so that care can be tailored to patients’ needs. At first, the new services were prioritising patients registered with the old Gender Identity Development Service, but I am delighted to report that the north-west and Bristol services are now taking patients off the general waiting list.

On the waiting list, Dr Cass’s review painted a picture of a service unable to cope with demand. Children and young people face unacceptably long waits for care, with some children passing into adulthood before their first appointment, leaving them facing a dangerous cliff edge. I am pleased to tell the House that NHS England is working with potential partner organisations to explore establishing a much-needed follow through service for 17 to 25-year-olds, as Dr Cass recommended. Young people’s distress or needs do not vanish when they turn 18, and neither should their healthcare.

We do not yet know the risks of stopping pubertal hormones at this critical life stage. That is the basis on which I am making decisions. I am treading cautiously in this area because the safety of children must come first. There are some who have called on the Government not to go ahead with the clinical trial recommended by Dr Cass. Others on the opposite side of the debate want the Government to ignore the recommendations of the independent expert Commission on Human Medicines. We are taking a different approach. The decisions that we take will always be based on the evidence and the advice of clinicians, not on politics or political pressure.

Finally, there are many young people in this country who are desperately worried and frightened by the toxicity of this debate. This has not been helped by some highly irresponsible public statements, which threatened to put vulnerable young people at risk. In the past few months, I have met young trans people, who either have been, may be, or will be affected by the decisions that I and my predecessor have taken. I have listened to their concerns, fears and anxieties, and I want to talk directly to them. I know it is not easy being a trans kid in our country today. The trans community is at the wrong end of all the statistics for mental ill health, self-harm and suicide. I cannot pretend to know what that is like, but I do know what it is like to feel that you have to bury a secret about yourself, to be afraid of who you are, to be bullied for it, and then to have the liberating experience of coming out. I know it will not feel like it, based on the decisions that I am taking today, but I really do care about this, and so does this Government.

I am determined to improve the quality of care and access to healthcare for all trans people. I am convinced that the full implementation of the Cass review will deliver material improvements in the wellbeing, safety and dignity of trans people of all ages, and the Government will work with them to help them live freely, equally and with the dignity that everyone in our country deserves. I commend this statement to the House.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

I thank the Secretary of State for advance sight of his statement, and for his courtesy in coming to the House to make an oral statement, which gives hon. Members the opportunity to ask him questions.

When the Secretary of State is wrong, we will challenge him robustly and hold him to account, but when he is right, we will support him. That is responsible opposition. In what he sets out today, he is right, and he has my support for what he is doing. Protecting children is one of the most important priorities that a Health Secretary can have. My predecessor, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), worked tirelessly to do just that. She set out that it was her priority to protect children and young people from risks to their safety from the prescription of puberty blockers, given the lack of an evidence base. I welcome the Secretary of State’s continuing the work started under the previous Government, and I welcome his support at the time and all that he has done since, including in his statement on 4 September. I associate myself with the three principles that he enunciated when he opened his statement.

With increasing numbers of young people questioning their gender identity, NHS England, with the support of previous Conservative Health Secretaries Matt Hancock and Sir Sajid Javid, commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. That historic review cut through the noise and ideology to lay bare the clear facts, so that we as policymakers can seek to make decisions based on evidence, safety and biological reality, and create a service that better serves the needs of children, as the Secretary of State set out. In the review, Dr Cass made it clear that not enough is known about the lifelong impacts of using puberty blockers on young minds and bodies to be sure that they are safe, and that the robust evidence base was simply not there. In March, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. With the support of the then Government, it announced that it was stopping children under 18 from being seen by adult gender services with immediate effect.

As one of the final acts of the previous Government, my right hon. Friend the Member for Louth and Horncastle used emergency powers under section 62 of the Medicines Act 1968 to extend the ban to private clinics selling puberty blockers to young people questioning their gender. It was the right thing to do, and I agree with and pay tribute to her, as I do to the Secretary of State for what he has subsequently done. The safety and wellbeing of children and young people must come above any other concern. I welcome the fact that the Secretary of State renewed the order; his saying that he will make the ban indefinite, given the absence at present of an evidence base; and his seeking to better understand and build that evidence base.

I have a few questions that I hope the Secretary of State can offer clarifications on in a constructive spirit. I hope—I think he alluded to this—that he will confirm that he intends to implement the Cass review’s recommendations in full. Of course, support must be available to children and young people who are questioning their gender identity, and that support must be holistic, multidisciplinary and evidence-led. The Tavistock clinic closed earlier this year, and as he set out, three new regional NHS children and young people’s gender services have opened to provide better, tailored gender services for children and young people—again, that is based on recommendations in the Cass review. Can the Secretary of State provide more detail on the delivery of the remaining regional centres, and say what order they are due to open in, so that children and families can see what is happening in their region? Again, that is about putting the best interests of young people first.

Can the Secretary of State reassure the House that these measures will be UK-wide and that he is working in tandem with the devolved Administrations? Will he advise on what progress has been made thus far—I appreciate that it is early days—on further research into patient care and increasing that evidence base? Can he update the House on the steps taken to continue the work of his predecessor, my right hon. Friend the Member for Louth and Horncastle, when she announced to the House in May the decision to work to close any online loopholes to the regulations put in place? Finally, will he commit—I suspect I know the answer to this one—to keeping the House updated in the months and years ahead on developments in this space?

Our children and young people deserve healthcare that is compassionate, caring, careful and led by the evidence. I associate myself with the Secretary of State’s concluding remarks on the need for the debate to be conducted in a respectful and sensitive way, with the needs of children and young people at its heart. We will support measures that protect children, and support him in bringing forward such measures; we want to work constructively with the Government to give the next generation access to the right healthcare to meet their needs. I look forward to working with him in the months ahead.

[Wes Streeting]

I thank the shadow Secretary of State for the constructive way in which he has responded to the statement, and for the tone with which he has approached the issue. It is worth everyone bearing in mind that every word of statements in this House, and indeed online, are often hung upon by a particularly vulnerable group of children and young people. Many of them feel afraid about the environment in which they are growing up, as do their families. Establishing an environment in which we can discuss issues with their welfare and wellbeing at its heart is therefore the right way to approach these issues. As I have said many times before—and I am sure the shadow Secretary of State agrees—we need less heat and more light, and we can show leadership together in trying to provide that climate.

I am absolutely committed to the full implementation of the Cass review. The shadow Secretary of State asked about the implementation of new children and young people’s services on gender incongruence. As I said, the north-west London and Bristol services are now open. A fourth service is planned in the east of England for spring next year. We want a specialist gender service in every region by 2026, and of course I will keep him and the House updated on that.

I am working closely with my counterparts in the devolved Governments. I particularly welcome the engagement I have had with my counterpart in Northern Ireland and his predecessor, the hon. Member for South Antrim (Robin Swann), who is within my line of sight. I appreciate the way we have been able to work together on this and many other issues. The shadow Secretary of State asked about loopholes. I will keep the matter under close observation and review.

With regard to sanctions, penalties and enforcement, it is worth pointing out that breach of the order is a criminal offence under the Medicines Act 1968. It is a criminal offence to supply these medicines outside the terms of the order. That means pharmacists who dispense medicines against prescriptions that are not valid may be liable to criminal prosecution. It is a criminal offence to possess the medicines where the individual had responsible cause to know the medicine had been sold or supplied in breach of the terms of the order. There are fines and penalties associated with that, including case-by-case and regulatory enforcement by the General Pharmaceutical Council.

We have approached the matter in an evidence-based and considered way, and with the welfare and interests of children and young people at the heart of our decision making. I urge everyone else involved in the provision of health and care to do the same.

[Tonia Antoniazzi (Gower) (Lab)]

I thank the Health Secretary for his statement and for the manner in which he continues to handle this important issue. I welcome the fact that the Government are following clinical evidence, particularly in relation to children and young people, whose wellbeing and protection are paramount—that is the right approach. Given that the Cass review found insufficient evidence on whether puberty blockers are safe, and highlighted their potential harms, there are understandably concerns about the risks of trialling them. Can the Secretary of State reassure me that the upcoming trial will have robust safeguards, and will he continue to be led by the wellbeing and safety of children?

[Wes Streeting]

I can certainly give my hon. Friend that assurance. Better-quality evidence is critical if the NHS is to provide reliable and transparent information and advice to support children and young people, and their parents and carers, in making potentially life-changing decisions. That is why we support the setting up of the study into the potential benefits and harms of puberty-supressing hormones as a treatment option. The study team’s application for funding is going through all the usual review and approval stages ahead of set-up—including peer review, consideration by the National Institute for Health and Care Research funding committee, and ethical approval processes. We want the trial to begin recruiting participants in spring 2025. I am confident in the robust, appropriate and ethical way in which the trial is being established.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I thank the Secretary of State not only for the content of his statement, but for its tone and his recognition of the importance of such a tone in this place. For too long, children and young people who are struggling with their gender identity have been badly let down by low standards of care, exceptionally long waiting lists and an increasingly toxic public debate.

Before GIDS closed, more than 5,000 young people were stuck on the list for an appointment and waited, on average, almost three years for their first appointment. For teenagers going through what is often an incredibly difficult experience, three years must feel like an eternity, so change is desperately needed.

The Liberal Democrats have long pushed to ensure that children and young people can access the high-quality healthcare that they deserve. We welcome the NHS move to create multiple new regional centres, but those centres must get up and running as quickly as possible. Will the Secretary of State outline what steps the Government are taking to ensure that happens in every region, and will he give a timetable for that work? Tackling waiting lists and improving access to care must be priorities.

I understand why today’s news is causing fear and anxiety for some young trans people and their families, who have been badly let down for so many years—not least those I have met in my constituency, who have highlighted the catastrophic mental health impacts of the situation. It is crucial that these sorts of decisions are made by expert clinicians based on the best possible evidence. Will the Secretary of State publish all the evidence behind his decision, including the results of the consultation, to give those families confidence that this is the right move for them?

We welcome the announcement of a clinical trial. We need the NHS to build up the evidence base as quickly as possible, and the Government to provide certainty that they will follow evidence and expert advice on behalf of those children.

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her approach to this matter. I can certainly respond to her questions. We want all those regional centres to be up and running by 2026, and we are working with NHS England to achieve that outcome.

The hon. Lady mentioned the waiting lists. To give people a sense of the challenge, the latest figures show that 6,237 children and young people are on waiting lists for gender services, so we have seen growth in the waiting list in the time that she mentioned. As with all NHS waiting lists, I want to see those numbers fall. It is particularly important to note, in the context of children and young people’s services—be they gender identity or other paediatric services—that a wait of many years can represent a school lifetime. I know that for that group of children and young people, time really does feel of the essence, so we owe it to them to get the waiting lists down faster.

We are also working to implement the recommendation on the follow-through service for 17 to 25-year-olds. I know that there is some anxiety about that issue—some people have interpreted it as an extension of children’s services up to the age of 25, but that is not what we intend. It is about a transitional service from children’s to adult services, which I think will lead to better care.

Finally, in the context of a statement that focuses on puberty-suppressing hormones, it is worth pointing out that they are not the only treatment for children and young people in this area. I think there is a danger that the focus on that treatment—because of an inevitable but necessary political process—means that it is held up as the gold standard, so some children and young people and their families feel that if they miss out on it, they are missing out on all treatment. That is not the case. Indeed, for many trans people of all ages in our country, puberty blockers have never been considered an appropriate intervention. We must see all the treatment options in the round, which is why I support the holistic approach to supporting children and young people with gender incongruence, as Dr Cass outlined in her excellent report.

[Alex Sobel (Leeds Central and Headingley) (Lab/Co-op)]

I thank the Secretary of State for addressing the points in my letter to him, particularly on the holistic approach to the health of trans young people. In his statement, he said that the order would

“restrict the sale or supply of puberty blockers”

to under-18s through private prescriptions. Can he assure me that that will apply to all under-18s, not just those with gender dysphoria? Otherwise, it will be used as an attack on trans young people, as he well knows. Is the order universal rather than targeting trans young people in particular?

[Wes Streeting]

The order relates to the use of puberty blockers by that particular group of patients for that particular purpose, where the evidence base is not sound and for which the Commission on Human Medicines has described the current prescribing environment as representing an “unacceptable safety risk.” Puberty blockers are safe and proven for use among children and young people for other conditions, including precocious puberty. Where we lack a sound evidence base and a safe prescribing environment, and where that medicine represents an unacceptable safety risk, is in relation to its use for that particular purpose for that particular group of patients.

[Rebecca Paul (Reigate) (Con)]

I welcome the statement and commend the Secretary of State for putting the safety and wellbeing of children first. The use of puberty blockers to treat gender dysphoria is—I will not mince my words—nothing short of a medical scandal, in my view, so I very much welcome his approach. He said that it is important that young people receive the right care from paediatricians and mental health professionals. Does he agree that no child should ever be told by a health professional that they were born in the wrong body?

[Wes Streeting]

It is important, particularly with this group of children and young people, that clinicians ask a range of questions to identify the nature of a child’s needs, and respond appropriately by providing holistic and evidence-based healthcare. That is the best way of turning around the horrendous statistics on the effects of gender dysphoria on children and young people, and it is how we will achieve better, healthier and happier outcomes for that cohort of patients.

[Kate Osborne (Jarrow and Gateshead East) (Lab)]

I wrote to the Secretary of State this morning, before his statement was announced, to highlight that a Council of Europe report notes that gender-affirming hormone therapy for trans minors in the UK is almost impossible to access, and that the total withdrawal of access to healthcare outside of a research trial may breach the

“fundamental ethical principles governing research”.

The restrictions on puberty blockers remove the clinical expertise from medical decision making, which significantly impacts on young trans people and their families, and I am hugely disappointed by the content of the statement. Will he read that Council of Europe report, and will he agree to meet me, as a UK delegate, to discuss it?

[Wes Streeting]

I am certainly happy to continue meeting my hon. Friend on this issue. With great respect to the Council of Europe and the authors of the report that she mentions, I have to take decisions about the welfare, wellbeing and safety of children in this country based on clinical evidence. When our own Commission on Human Medicines says that there is an “unacceptable safety risk” and an unsafe prescribing environment, I have to take that seriously. When one of our country’s leading paediatricians says that there is insufficient evidence about the long-term effects of the use of this particular drug for this particular purpose for this particular cohort of children and young people, I have to take that seriously.

I know there are people who will be deeply disappointed by this decision, including many trans people and their families. Thinking about some of the young people I have met in recent weeks and months, I have taken to heart what they have said, and I know this will be deeply upsetting to them. I do not take that lightly, but to anyone challenging me to do something else, I ask them quite sincerely whether if they were standing in my shoes as the Secretary of State for Health and Social Care, looking at recommendations from clinicians in our country—including the Commission on Human Medicines—saying that there is insufficient evidence for the use of medication in children and young people for this purpose and an unacceptable safety risk arising from the current prescribing environment, they would really take a different position.

[Siân Berry (Brighton Pavilion) (Green)]

I am extremely worried and fearful about this decision to continue the blanket ban, and I want to ask the Secretary of State about his reliance in the terms of reference and reasons for this decision on the purpose for which these drugs are being prescribed—that is, being trans—when they are safely used by young people for other conditions, as he acknowledges. Does he understand that this is, at heart, discriminatory?

[Wes Streeting]

I do not agree with the hon. Member’s characterisation. A whole range of medicines are prescribed for a whole range of uses among a whole range of patient cohorts that may well be unsafe, inappropriate or ineffective for use by other patients with other conditions. That is a basic fact of medicine and, if I may say so, the hon. Member’s intervention is why we should listen to clinicians, not politicians.

[Nadia Whittome (Nottingham East) (Lab)]

I share the deep disappointment that many young trans people and their families will feel about the Health Secretary’s decision today. I know that many will be devastated by this news, and I know that they have communicated to the Health Secretary and his Department the huge concerns that they have about their wellbeing in the face of these restrictions. Too many young trans people are already in, or at high risk of, mental health crisis. What consideration has he given to the impact of this decision on their mental health?

[Wes Streeting]

Very heavy consideration—of all the considerations, it is the one that has weighed most heavily. As I said in my statement, trans people too often find themselves at the wrong end of the statistics on mental ill health, self-harm and suicide. I take those issues very seriously indeed.

What I would say to my hon. Friend, Members of this House, and campaigners—particularly online actors—is that a number of claims have been made about the data that are not borne out by the facts. In fact, I asked Professor Louis Appleby, the Government’s suicide prevention adviser, to examine the evidence for some of the claims made that there has been a large rise in suicide. His paper, published on 19 July, concluded as follows:

“The data do not support the claim that there has been a large rise in suicide in young gender dysphoria patients at the Tavistock.

The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide.

The claims that have been placed in the public domain do not meet basic standards for statistical evidence.

There is a need to move away from the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of health care.

We need to ensure high quality data in which everyone has confidence, as the basis of improved safety”.

I would add that it is important that we make sure that these children and young people have access to good-quality mental health support, and I am working with NHS England to make sure that this is the case. This area is one in which all Members should tread carefully when engaging in debate.

[Sir Julian Lewis (New Forest East) (Con)]

I do not think anyone who has listened to the Secretary of State today could be in the slightest doubt about the responsibility that he has borne and the personal empathy that he has injected into his handling of this very difficult question. I personally thank him for it.

I was told a long time ago that one should never ask a question in the House to which one does not already know the answer, but I think I will break the rule this time. What about surgical procedures? One hears about irrevocable steps such as so-called top surgery—the removal of healthy breast tissue from young females. Where does the law stand on that issue at the current time?

[Wes Streeting]

The only thing worse than a Member not knowing the answer to their own question is the Minister not knowing the answer. Happily, in this case, I can say that surgical intervention for trans people does not apply to children and young people.

[Peter Swallow (Bracknell) (Lab)]

I welcome the spirit in which the Health Secretary has made today’s statement and his commitment to improving healthcare for all trans people, but I want to press him a bit on continuity of care. This summer, I had a real struggle working with parents of young trans kids who were supporting their children in their journey and had accessed puberty blockers through overseas prescribers. They had done so after much heartfelt indecision, because they thought they were supporting what was best for their children and, frankly, because better healthcare options were not available to them under the previous Government. I welcome the moves taken to speed up the trial, but can my right hon. Friend assure me that while we wait for that trial to be set up, nobody currently receiving treatment with puberty blockers—however they may have accessed them in the past—will face a discontinuity in their care?

[Wes Streeting]

Any young person in Great Britain and Northern Ireland who had a valid prescription for these medicines in the six months prior to 3 June and 27 August respectively can seek continuation of their prescription from a UK-registered clinician. Guidance has been issued to general practitioners setting out prescribing scenarios. It remains the case that continuation of puberty-supressing hormones can be considered where the GP feels competent to do so, and where confirmation in the form of documentary evidence that treatment had been under way is available. The guidance also makes clear that GPs should consider what further support should be offered, including assessing whether referral to the children and young people’s gender service or, indeed, for mental health support is required.

[Christine Jardine (Edinburgh West) (LD)]

I, too, thank the Secretary of State for the empathetic and reassuring approach he has taken today, because this has been a very toxic and, in many ways, very damaging debate for everyone involved. Further to the question about continued care, what reassurances can he give to people who have embarked on a course of treatment that they might now fear will be halted, and to the very many young people and their families in this country who are going through a very difficult time? Desperate situations make people do desperate things. What steps is the Secretary of State taking to ensure that the availability of these drugs is not driven underground—that they are not made available through means that none of us would like to see?

[Wes Streeting]

As I say, any young person in Great Britain and Northern Ireland who had a valid prescription for these medicines in the six months prior to 3 June and 27 August respectively can seek continuation of their prescription from a UK-registered clinician. More broadly, it is my intention to ensure we start bringing down those waiting lists, to make sure that children and young people and their families receive access to the wide range of support, information, advice and guidance that they need in order to navigate their pathway and to make sure they feel safe, respected and included in discussions about their own healthcare.

[Ms Stella Creasy (Walthamstow) (Lab/Co-op)]

The Health Secretary is right when he says that young trans men and young trans women in this country need us all to do better on their behalf, particularly in the debate and how we move forward—there must be more light, not heat. He is also right when he says that time is of the essence. I think we all share his concern that all medicines must be regulated properly and that we should all understand, for every patient group, the risks and benefits of any medication. However, can he give us more clarity, and give those who will be listening to this statement in fear a sense of where this is going? He has talked about an indefinite ban until 2027—not a rolling ban, but an indefinite ban—and he has talked about recruiting participants to a study that might begin its recruitment in 2025, but he has not said when the review will begin or when we will get the data that he feels is missing and that Dr Cass identified as needing to be provided so that we can move the debate forward. If time is of the essence and puberty is the matter, we need to give these young people a route map forward.

[Wes Streeting]

I am grateful to my hon. Friend for her question. We are trying to proceed at pace with the clinical trial. I share the urgency that she brings to her question. I have had to temper my own urgency with the need to make sure that the clinical trial that is established is as robust and ethically sound as, if not more robust and ethically sound than, any other clinical trial. The worst thing I could do at this stage, especially when the NIHR and NHS England are working at pace to establish a trial, would be to interfere politically in what must be an independent approach.

The planned pathway study, which includes the clinical trial component to build the evidence of the relative benefits and harms of puberty-suppressing hormones, is in the final stages of the commissioning process, subject to a robust ethical approval process. The study remains on track to commence recruitment in the spring, and I will issue further updates in early 2025 to keep my hon. Friend, the House, and young people and their families informed.

[Carla Lockhart (Upper Bann) (DUP)]

I am sure the Secretary of State will welcome the Northern Ireland ban as well, making this a UK-wide ban.

Going through puberty is a biological and natural way for a boy or girl to develop. Anything that interferes with this process in such an extreme way is going against the natural process. Therefore, I agree with the sentiments about its being a scandal that medicine was being given to vulnerable young people without proof of its being safe or effective. Will the Secretary of State therefore outline what support is available for children and young people who have taken these drugs and bear the scars of these drugs? On the clinical trial, we once again see the NHS being used totally contrary to what it was designed for, which is to protect and preserve life.

[Wes Streeting]

I thank the hon. Member for her question. On the cases of young people who have been on a gender identity pathway and later regret those interventions, whatever those interventions may have been, they are small in number, but they are addressed in the Cass review. It is important that we do not lose sight of those young adults and older adults who may well need the support of health services if they feel they were inappropriately placed on a gender identity pathway or undertook medical interventions that they have later come to regret. We will keep that and other evidence under close review.

[Jonathan Davies (Mid Derbyshire) (Lab)]

I thank the Secretary of State for his statement and the sensitive way in which he has approached this issue, because nothing is more important than our children and young people’s health. A lack of an evidence-based approach may have taken us into a space where some children and young people have received puberty blockers as an appropriate intervention, but others have received that medication when it was not right for them, so can I ask him or his officials to look at how we got ourselves into that space? There may be lessons for us to learn not just about this issue, but about healthcare more generally. Sometimes when we have rushed into things in the past, we have found what appears to be a panacea for an issue, but it has turned out not to be the right thing at all.

[Wes Streeting]

I am grateful to my hon. Friend for his question. This lies at the heart of the dilemma that has plagued clinical leaders and political leaders, particularly since the scandal at the Tavistock clinic was brought into the public eye. There are many people in our country—young people, and young and older adults—who will say, and some have certainly told me in my office, that having access to puberty-suppressing hormones has been completely life-changing and affirming, and has led to a positive outcome for them. Yet we know that the prescription of that medication to this particular group of patients for this particular medical need has not been supported by underpinning evidence in the way that the use of other drugs has been underpinned by effective trials and an evidence base.

That has been the challenge: people with a lived experience saying that this has been positive, while none the less—at the Tavistock clinic, in particular—not only puberty blockers but a whole range of medical interventions were delivered with the best of intentions, but in ways that were inappropriate and clinically unsound. That was the genesis of the Cass review, and it is why I think it is so important that we proceed in an evidence-based way. To do the contrary risks real harm to people and also a lack of trust in the medical profession that will be damaging for our entire country, and particularly for this group of patients.

[Joy Morrissey (Beaconsfield) (Con)]

May I thank the Secretary of State for a very nuanced, well thought out and genuinely moving statement? He will very rarely hear me praise those on the Labour Front Bench, so he should enjoy it. I thank him for taking what is a very difficult stance. What I saw is that the Secretary of State has put young people first and has protected young people today. I am very grateful for that, and I would like to offer him my thanks. I also thank him for his nuanced approach in helping trans people in their transition in adulthood, because this is complicated and it needs a nuanced approach. I thank him for understanding that, and for his boldness today.

[Wes Streeting]

I thank the hon. Member for her question. In case she worries that she is going soft on the Government—or, worse still, in case I worry that I agree with her—we should just remind each other that even a stopped clock is right twice a day. For those watching our proceedings this afternoon, it is true to say that politics in our country has been quite divided on a wide range of issues, certainly in the nine and a half years that I have been in this House. However, that is not to say that, on a wide range issues, we do not have consensus or work together to build it. I actually think that is a good thing in our politics. There are plenty of things we can disagree about in this House and contest elections on, but especially in an area such as this that involves vulnerable children and young people, the more we can try to build consensus and create an environment in our country where these children and young people and their families feel safe, the more we will be doing a really good job.

Far and away the hardest part in this process for me personally has been spending time with these children and young people and their parents, many of whom have spoken in genuinely heartfelt terms about the fear they feel living in our country. Some are looking to live in other countries, and doing so quite sincerely. It breaks my heart, actually, because I want this country to be one where everyone, whatever their background, feels safe, included and respected, and there is much we can do across this House to build that kind of country.

[Emily Darlington (Milton Keynes Central) (Lab)]

I thank the Secretary of State for his recognition of how difficult it will be for many young trans people and their families to hear the news today, and for his comments about the wider environment in which the trans community is threatened every day in the UK.

My significant concern about the announcement is that it will lead to more people getting drugs from unknown sources online without prescription, and God knows what is actually in some of those drugs. I also have significant concerns about access for both young and older trans people to the services they need. We know that there is currently a six-year waiting list, and it is estimated that those joining the list today, if things are not improved, will have to wait 15 to 20 years before actually accessing any specialist services or starting any treatments. Can the Secretary of State reassure trans people across this country, both young and older, that we are committed to making sure they get the health services they need as quickly as possible?

[Wes Streeting]

I can certainly give my hon. Friend that assurance. We want all trans people, in fact all people in our country, to receive timely access to safe and effective healthcare. We want to improve services for trans people specifically, because we recognise the extent to which they have been let down. I emphasise that young people who have been in receipt of puberty blockers with a valid prescription for the six months prior to 3 June and 27 August respectively can seek continuation of their prescriptions. There are risks that would be associated with an interruption of those prescriptions, which is why we have taken that approach. I know that I speak for the Government as a whole in saying that whether it is access to healthcare as in my case, access to a wide range of public services, or indeed safety on our streets, this Government are committed to improving the lives of trans people so that they can live with the freedom, dignity and respect that any of us in our country would expect for ourselves.

[Jim Shannon (Strangford) (DUP)]

I very much welcome the Secretary of State’s statement. It is never easy to deliver a policy decision that has so much effect on people, and I admire him for his diligence and his courage. He will be aware of the findings of the Cass report, which found that the change in practice from psychological and social support to drugs was based on no good evidence. In the light of medical professionals highlighting that puberty blockers by definition disrupt a crucial natural phase of human development, does the Secretary of State believe that we must extend the ban from temporary to permanent, not only to protect our children, but to prioritise mental health and the support that they so desperately need?

[Wes Streeting]

I am grateful to the hon. Gentleman for what he said. These issues weigh heavily on my conscience. On what he says about the safety and efficacy of puberty blockers, the simple fact is that we just do not know enough. That is why building the evidence base and research is important. I want to ensure that young people with gender incongruence and dysphoria are receiving the best quality healthcare to improve their safety, welfare and wellbeing as children, and that they live long, healthy and happy lives as adults. That is the basis on which we are taking decisions, and we are approaching the issue with care and sensitivity, as I know my counterpart in Northern Ireland also does.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

Today will be a difficult day for trans young people, not because of the Secretary of State’s statement, but because of how our media might choose to portray what has been announced in the House. I welcome the remarks of the shadow Secretary of State, and I hope that we can take things forward together.

I know that one of my constituents will be upset, but will reflect on this with his mum, who has been supporting him. He was referred by his GP for gender dysphoria when he was in year 8. He has still not been seen by a specialist, and he is now in his first year doing his A-levels. He has had to endure going through periods, and suffering at school with the embarrassment of that. He decided to stop eating and was diagnosed with anorexia because that was the only way that he felt he could stop his periods and stop his breasts growing. Those are the kinds of things that trans young people go through day in, day out. Three and a half years later, it is not good enough that he has still not been seen by a medical professional. He is in the west midlands, which is one of the areas where we are not yet announcing that specialist services will be extended.

I welcome the gravity with which the Secretary of State has dealt with this matter. In particular, he responded to me when I asked him to meet trans young people, which he has done. I hope that we can move forward together and improve the mental health of all our young people. We must take this issue seriously and work together, rather than make this into a culture war.

[Wes Streeting]

My hon. Friend demonstrates powerfully why waits of the length that she describes in that case are simply unacceptable and unjustifiable. She also details the real pain that is being experienced by young people who are not being seen by the NHS, and not receiving the care and support they need. That is why I am determined to improve waiting times and quality of care. It is also why those of us in positions of influence or power, or those who have access to the microphone or the pulpit, need to think very carefully about the way that we talk about this group of children and young people, and trans people more generally. It is why headline writers and editors in our media have a responsibility to think carefully about how they exercise their freedoms in the media responsibly—freedoms I strongly support—and create a culture where we are not adding to the harms of that group of children and young people. That is for the exact reasons that my hon. Friend describes with that utterly heartbreaking case.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I associate myself with the remarks of my hon. Friend the Member for Beaconsfield (Joy Morrissey) about both the tone and content of the Secretary of State’s remarks. I first raised my concerns about the Tavistock clinic back in 2019, when a number of professionals resigned because they were so concerned about what was happening with regard to prescribing. He will know that anyone who raised those issues—I think of Kathleen Stock, for example—has been treated very poorly, and with spite, by some of the militant activists in that field. Although I entirely recognise the tone that the Secretary of State adopts—he is a thoughtful and sensitive man—I must ask him this. He has been clear that the prescribing practice was inappropriate, that people were not given time to give their full and informed consent, and that it was an unacceptable safety risk. Who oversaw that? When were those decisions made? Who made them, and how will they be held to account? Many young lives have been severely damaged.

[Wes Streeting]

As the report into the failures of the Tavistock clinic shows, a whole range of individuals and organisations did not discharge their duty of care appropriately to an extremely vulnerable group of children and young people. I pay tribute to the whistleblowers of the Tavistock and Portman who laid their careers on the line. They were subjected to the worst kinds of attempts to silence whistleblowers, and in some cases to bully them out of the organisation or vilify them. That was not only a disgraceful way to treat good colleagues who were raising legitimate concerns in the right way, but ironically—I have no doubt that many of the people behaving in that way did so with the best of intentions towards that vulnerable group of children and young people—they set back the national conversation about that group of children and young people and undermined confidence in gender identity services. That cannot be a good thing.

I also pay tribute to those journalists who were willing to report on this issue. I pay particular tribute to Hannah Barnes, whose “Newsnight” investigation took some of these issues to a wider audience, and whose journalism on broadcast media and in print showed how we can expose failure, and expose the risks to a wide range of children, young people and adults, in a thoughtful, evidence-based way.

Finally, the right hon. Gentleman talked about the treatment of other people who have raised concerns in a wide range of contexts in this debate. He mentions Kathleen Stock, and there are others, too. I do not think that has been helpful; in fact, I think it has been actively harmful to having the kind of national conversation we should have more broadly about gender identity and how some women fear their sex-based rights are at risk. If we were able to navigate those issues in a much more thoughtful, considered way, listening to different perspectives and experiences, I feel confident that, despite all the challenges, as a society we could find a way through that not everyone loves, but everyone can live with. We have done that before on same-sex marriage, on sexual orientation and religious freedoms, for example. It is possible, if we are willing to listen, to engage in good faith and to not shout down people raising heartfelt concerns. Perhaps if we engaged in the conversation in a much better way, we would find a better way through as a country.

[Vikki Slade (Mid Dorset and North Poole) (LD)]

While I am deeply disappointed, on behalf of our trans children, by the Secretary of State’s statement, I thank him for speaking directly to those children. I know that they will appreciate his sentiments. Trans young people in Mid Dorset and North Poole already rely increasingly heavily on their GPs, their schools and CAMHS, with many leaving education entirely, doing serious harm to themselves and losing their lives while on the waiting list.

The former director of Tavistock told me that no data was collected on incidents of assisted suicide and deaths of children who were on the waiting list. Data was collected only of children and young people who had already started treatment. As a result, we have no information about the harms that young people and their families are going through in those years leading up to treatment.

What assurance can the Secretary of State give me that those already under the care of CAMHS and paediatricians will be treated urgently? Can he update me on progress on how long those already on the list might expect to wait? Will he commit to collecting data from families on the waiting list, so that we can truly understand their experiences?

--- Later in debate ---

[Wes Streeting]

The hon. Member points back to the waiting list, which currently has 6,237 people on it. I do not think it is too much to expect the NHS to have a relationship with each of those young people and to make sure that they are receiving some support and care while they are waiting. I have been given assurances that support is offered to young people on the waiting list, and I continue to monitor that like a hawk. I am grateful for representations I receive from across the House from right hon. and hon. Members’ casework, and I am happy to pick up individual cases.

As for the most catastrophic failures of children and young people, I reassure all right hon. and hon. Members that all child deaths, whatever the circumstances—suicide has been mentioned—undergo a multi-agency review by a child death overview panel, and that information is reported to the national child mortality database. There is a monthly exercise by NHS officials to check the waiting list against NHS records, so we do monitor the situation closely, and the mental health and wellbeing of this particular cohort of children and young people is both very close to my heart and very close to my gaze.

[Jim Allister (North Antrim) (TUV)]

I certainly welcome the Secretary of State’s extension of the ban on the prescription of puberty blockers. I want to ask him whether he has more information for us on the criteria that will apply for entry into the clinical trials. Will there, for example, be a minimum age? Will parental consent be required? Both those things seem to be important, so may I have assurance on those two points?

[Wes Streeting]

The details of the trial are still being worked through. They will be and are subject to a robust ethical approvals process. Only once final ethical approval is granted is the final study design set in stone. As such, I cannot comment on the finer details at this time, but I just reassure the hon. and learned Member that the issues he raises are very much under consideration in the design of the trial.

[Carla Denyer (Bristol Central) (Green)]

I share the concerns expressed by experts at the Council of Europe that removing access to puberty blockers except through clinical trials may breach the fundamental ethical principles governing research, amounting to coercion and therefore a breach of young people’s human rights. Exactly how harmful that decision is, however, hinges on how easy or hard it is to get on the clinical trial. How many places will there be on the trial? If he cannot at this stage, can he please reassure me that he will take careful consideration of the fact that if the trial is limited in size, that will cause harm to more trans and gender-questioning young people.

[Wes Streeting]

The trial will be uncapped, and I reassure the hon. Member and the House that all NIHR-commissioned research must go through robust scientific and ethical approval processes, both of which can influence final study design. In terms of the design of this trial, ethics is an integral part of the trial’s approval.

[Robin Swann (South Antrim) (UUP)]

I thank the Secretary of State for his statement, which I welcome, both in its tone and the approach taken. I welcome that this indefinite ban will include Northern Ireland. I thank the Secretary of State and his predecessor for the collaborative approach they have taken with the Minister of Health in Northern Ireland. It is important for the House to note that the ban in Northern Ireland was supported by all the Northern Ireland Executive parties. In his statement, the Secretary of State talks about being able

“to restrict the sale or supply of puberty blockers…through a prescription issued by…a prescriber registered outside the United Kingdom.”

What steps will he take to close all those loopholes and avenues that would allow these drugs to be prescribed, recommended or supplied by online suppliers for under-18s?

[Wes Streeting]

The challenge that the hon. Member mentions relates not just to these drugs, but goes more generally, too, and it is something we are looking at closely. More broadly, I want to acknowledge the first part of his question. I am grateful, not just to my counterpart Mike Nesbitt in the Northern Ireland Executive, but to the First Minister, the Deputy First Minister and all parties involved in the Northern Ireland Executive for the collaborative way and the spirit in which they have engaged in discussion about this issue for Northern Ireland, and also for their willingness to work in partnership with the UK Government. That is to their credit and to the benefit of all citizens across every part of the United Kingdom.