Cass Review

– in the House of Commons am 5:23 pm ar 15 Ebrill 2024.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care 5:23, 15 Ebrill 2024

With your permission, Madam Deputy Speaker, I would like to make a statement on the Cass review of gender identity services for children and young people. May I say how pleased I am that we are joined by parents of children who have been affected by some of the issues raised in this review? I hope all of us will bear the sensitivities of this debate in mind as we discuss it this afternoon.

This review strikes hard and sure at an area of public policy where fashionable cultural values have overtaken evidence, safety and biological reality. This must now stop. As recently as 2009, the NHS’s sole gender identity development service at the Tavistock and Portman NHS Foundation Trust received fewer than 60 referrals for children and young people, and just 15 for adolescent girls. Since then, demand has surged. By 2016, over 1,700 children and young people a year were referred—a 34-fold increase. More than half were teenage girls. In 2022, more than 5,000 children and young people were referred to gender identity clinics, and almost three quarters were female.

This exponential increase in demand is not a coincidence; it has been driven by a number of factors which I will come to later, but at its heart it was driven by a myth. This myth was that for children and young people grappling with adolescence who were questioning their identity, their sexuality or their path in life, the answer to their questions was inevitably to change gender to solve their feelings of unease, discomfort or distress.

That near-uniform prescription was imposed on children and young people with complex needs without full and thoughtful consideration of their wider needs, including, as is set out in the report, conditions such as neurodiversity, experiences such as childhood trauma or mental health conditions, or indeed discovering who it is that they may one day fall in love with. Indeed, the response from some of the people who should have protected them—some of the clinicians in charge of their care at the Tavistock clinic—was almost always to put them on an irreversible path: blocking puberty, then prescribing cross-sex hormones, and on to surgery as an adult. In other words, such professionals were not asking the right questions of themselves or of their patients.

That is why in 2020, with the support of my predecessors, my right hon. Friends the Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sir Sajid Javid), NHS England commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. I would like to start by thanking Dr Cass and her team for undertaking a considered, comprehensive and courageous review into an extremely contentious area of healthcare. Since NHS England commissioned the review in 2020, they have meticulously unpicked what went wrong, what the evidence really shows and how to design a fundamentally different service that better serves the needs of children.

I must also thank those who raised the alarm and contributed to the review over the last four years: the clinicians who spoke up against their peers to blow the whistle about what was happening at the Tavistock clinic, even though it risked their careers; the journalists, academics and activists who listened to their stories and investigated further, even when they were derided as bigots and transphobes; the parents who were just trying their best to support their children, but were so badly let down by a service that vilified them for questioning whether the interventions offered were right for their children; and, of course, the young people themselves who have shared their experiences, including those who have gone through the pain of de-transitioning only to find out that the so-called “reversible” treatments they were offered are not in fact reversible.

The Cass review makes for sober reading. It is extremely thorough, so I will not attempt to cover all its recommendations today, but I genuinely encourage all Members to read the report in full. It should concern every single Member of this House that part of our public space—the NHS—was overtaken by a culture of secrecy and ideology that was allowed to trump evidence and safety. We say enough is enough; our young people deserve better, and we must do whatever it takes to protect them.

Since the publication of Dr Cass’s interim report in 2022, a series of important changes have been made, and I put on record my thanks to NHS England’s chief executive, Amanda Pritchard, and all those at NHS England who have worked hard with Dr Cass to implement them. On 31 March, the Tavistock clinic finally closed, having stopped seeing new patients a year earlier. Two new regional hubs have been opened, in partnership with the country’s most prestigious children’s hospitals, to ensure that children are supported by specialist, multidisciplinary teams. Indeed, another hub will follow in Bristol later this year.

In the past few weeks, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. On the day of publication of Dr Cass’s final report, it announced that it is stopping children under 18 from being seen by adult gender services with immediate effect, and an urgent review on clinical policy for cross-sex hormones will now follow without delay. I also welcome NHS England’s plans to bring forward its full review of adult services, including Dr Cass’s recommendation for a follow-through service for young people up to the age of 25.

I also share Dr Cass’s concerns that clinicians who subscribe to gender ideology will try to use private providers to get around the rules. Let me give a very clear warning: prescribing is a highly regulated activity, and the Care Quality Commission has not licensed any gender clinic to prescribe hormone blockers or cross-sex hormones to people under the age of 16. Any clinic that does may be committing extremely serious regulatory offences for which its licence can be revoked and its clinicians can be struck off. My officials have been in contact with the CQC following the final report to ask that it looks again at the age thresholds in its licensing conditions.

The CQC has also reassured us that it will incorporate Dr Cass’s recommendations into their safe care and treatment standards for all care providers. That means that all new providers will be asked if their practices respect the Cass review, and all existing providers have to meet the same rigorous standards when they are reviewed by the CQC. My officials met the General Medical Council over the weekend, and will do so again in the coming days, to understand how it will ensure that every clinician on its register follows its code of practice and implements the wider findings of the Cass review.

It is morally and medically reprehensible that some online providers not registered in the UK have stated their intention to continue to issue prescriptions to children in this country. I am looking closely at what can be done to curtail any loopholes in prescribing practices, including legislative options. Nothing is off the table, and I will update the House in due course as we progress that work at pace.

Dr Cass also found that there was a lack of robust data on what happened to the 9,000 children who were treated by gender identity services between 2009 and 2020. Many went on to continue their treatment at adult clinics, and the University of York had been due to research the long-term consequences of treatment they received as children, so that we can properly support them through their journey into adulthood. It was expected to provide important insights into the clinic’s work, including how many patients de-transitioned and how many were also diagnosed with a mental health condition or an autism spectrum disorder.

This Government took the unprecedented step of changing the law to make it possible for adult gender clinics to share medical data with the university. All bar one of the adult gender clinics refused to co-operate with this vital research. To quote Dr Cass, that is “unacceptable”, but I would go even further: I think it is deplorable and a dereliction of their professional duty. I am pleased to update the House that following the publication of Dr Cass’s report, I have been informed that all seven clinical leads for the adult gender services now intend to fully participate in this important work.

Dr Cass also concludes that a cultural shift alone “does not adequately explain” the huge growth in young women being referred to gender services. She paints an alarming picture of digitally engaged young women who are frequently exposed to pornography involving violent, coercive, degrading and pain-inducing acts. Is it any wonder than more and more of them are looking for ways to opt out of becoming women? That is deeply troubling and, as Dr Cass makes clear, we have a duty to support those young women with considered, evidence-based care.

Our children deserve healthcare that is compassionate, caring and careful. Their safety and wellbeing must come above any other concern, and anyone who threatens it must be held to account. I will work with NHS England to root out the ideology that has caused so much unnecessary harm, to support those who have already received life-altering treatment, to give the next generation access to holistic care, and to protect our children’s futures. Anything less would be neglecting our duty to the next generation. That will not happen under this Government, and it will not happen under my watch.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care 5:35, 15 Ebrill 2024

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 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.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

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.

Photo of Jackie Doyle-Price Jackie Doyle-Price Ceidwadwyr, Thurrock

The report is very welcome, but it has been a long time coming. One issue I would like to put to my right hon. Friend is the whole failure of governance that it shows. In particular, NHS England’s specialist commissioning requires challenge. As she explained, what was initially commissioned as a treatment course for a small minority of people has been allowed to expand unchecked and without any consideration of the ethics of what was being done to children. What will she do to ensure that does not happen again? Secondly, the Tavistock clearly enjoyed the popularity brought by being at the front end of what was seen as a set of cutting-edge treatments. Frankly, the governors allowed that to get in the way of what they should have been doing: ensuring patient safety. What does she propose to do about that as well?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend, who in her parliamentary career has done so much to shine a light on this sort of behaviour. She has espoused worries, both publicly and privately, about the children and young people at the heart of this matter. Looking to the future, the Tavistock clinic has shut. As I said, it stopped admitting patients a year ago. The new services that are already in place—the two new hubs, with plans to expand further across the country—are about ensuring a multidisciplinary approach to young people, so that, with exactly the experiences Dr Cass sets outs so starkly in her report, children are treated as human beings and patients, not as siloed conditions. One of the main problems that emerged with the Tavistock behaviour and the way it took place is that gender questioning was siloed in a way that no other health or mental health condition was. We want to move back to a place where clinicians are no longer scared of looking after children and young people with these issues, and that they see it as part of their general practice and general work. That is how we are best going to address the very complex needs of many of these children and young people.

Photo of Kirsten Oswald Kirsten Oswald Shadow SNP Spokesperson (Women), Shadow SNP Spokesperson (Equalities)

I am grateful for advance sight of the statement.

Nobody’s identity should be up for debate, and nor should it be used as a political football. Dr Cass said in her report:

“Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.”

That polarisation is the last thing needed by young people in accessing care, their families and the NHS staff working hard to care for them. Does the Secretary of State agree that we must all remain respectful at all times when discussing these important issues, and that decisions on this and any other type of treatment should rightly be made by clinicians, not politicians?

Dr Cass explicitly makes the point that her report is not about questioning trans identities or rolling back access to healthcare for young trans people. Indeed, supporting and improving the gender identity healthcare system for all, including children and young people, is what we should be focused on. So can the Secretary of State confirm today whether any additional funding will be made available to ensure that young trans people can access the quality healthcare they need and deserve?

Finally, on conversion practices, the Government Equalities Office said last month in an answer to a written question:

“The Government expects to deliver a draft Bill that takes account of the independent Cass review”.

Can the Secretary of State provide an update on what conversations she has had with Cabinet colleagues on how the Cass review will influence the UK Government’s legislative proposals on banning conversion practices, and when can we expect them to be published?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I encourage both the Scottish National party in Scotland and Labour in Wales—health is devolved in those countries, of course—to respond as quickly as possible to the findings of the review. The hon. Lady asks whether it is Barnett-ised. For these purposes, our work to ensure that the clinics meet the needs of our population in England is not additional money. We are re-prioritising within NHS budgets to ensure that the services are spread across the country. I encourage the Scottish nationalists to prioritise the needs of their children and young people in the same way.

I would also gently make the point that, when it comes to the atmosphere of this debate, I do not believe it has been helped by the SNP’s highly controversial Hate Crime and Public Order (Scotland) Act 2021. I note, for example, the behaviour and engagement on Twitter of very high-profile people in Scotland, and the impact that it has had when people have dared to name activists in this arena. I would also ask the Scottish Labour party to explain why it helped the SNP to pass that Act, because to me this seems to be all about the atmosphere.

Photo of Rosie Winterton Rosie Winterton Deputy Speaker (First Deputy Chairman of Ways and Means)

I call the Chair of the Women and Equalities Committee.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

Dr Cass’s observations about violent and degrading pornography are chilling, and we know of the impact that is having not just on young girls but on all our young people. Her recommendations also include significant and specific references to expanded services and follow-through services for 17 to 25-year-olds. What concerns has my right hon. Friend about the capacity for that, and about the possible impact on other areas of healthcare?

We know that the transition from children’s services to adult services can be problematic in the case of a wide range of services, not least for those suffering from body dysmorphia or eating disorders. Might there be any crossover, with young people having access to some sort of interim service before the age of 25, and will more funds be committed so that we do not continue to see what all of us will face in our constituencies: the horror of young people being unable to access child and adolescent mental health services before they turn 18 and become reliant on adult mental health care?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

My right hon. Friend is right to identify the cohort of young people between the ages of 17 and 25 as being of particular concern. Now that we have a clear pathway in relation to the treatment of children and young people under the age of 17, I have asked NHSE to focus primarily on that next cohort. Speaking to parents gives one a very real sense of their concerns about what they describe as the cliff edge between children and young people’s services and adult services for this very vulnerable group of young people. I do not want that to continue, and over the coming months we will see NHSE develop work to help that cohort.

My right hon. Friend has an understanding not just of how transformational the report and its evidence are, but of the challenges that this means for our health service in England and how we choose to respond. As for funding, NHSE has committed more than £17 million to the two new hubs in the current financial year, and I hope and expect that our devolved Administrations will commit similar sums to looking after children and young people in their areas.

Photo of Nia Griffith Nia Griffith Shadow Minister (Cabinet Office)

The Secretary of State has spoken of the need for multi-site centres, and has pointed out that two hubs have already been established. Will she tell us a little more about her plans to expand this to make it multi-site, and when that is likely to happen?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

As I have said, we hope to expand it to Bristol later in the year, and there will be a further three or four sites across England. However—this is a really important part of the report—this is not just about specialist services but about giving clinicians the necessary confidence to look after children and young people who may well be presenting at their clinics or surgeries with this condition as one of a number of conditions. We want to give them back that confidence, and the comfort of knowing that they need not just go down the narrow pathway of specialist services. Of course that will be appropriate for many, but we want to treat the whole child rather than treating just this particular condition, as has happened in the past.

Photo of Dr Caroline Johnson Dr Caroline Johnson Ceidwadwyr, Sleaford and North Hykeham

I must first declare my interest as a practising NHS consultant paediatrician whose practice sometimes involves caring for children with the condition we have been describing.

The Cass Review makes for sobering reading. This is an example of ideology being allowed to trump evidence and safeguarding. Let me give the Secretary of State a specific example. Individuals have thwarted the attempts of those working on the report to conduct research that would give them a better understanding of the outcomes for some children. I am pleased to hear that those people are now co-operating, but we should note the contents of a letter from John Stewart, the national director of specialised commissioning, which is appended to the report. He says that although NHS England wrote to the chief executives and medical directors of all NHS trusts, the research data was not released. One of the duties of doctors that are specified by the General Medical Council is to

“Engage with colleagues to maintain and improve the safety and quality of…care.”

May I ask the Secretary of State who exactly blocked that data, what investigations will be carried out to find out which individuals were responsible, and how they will individually be held accountable for their actions? How was it possible for them to do this in the first place, and what is she doing to ensure that data cannot be blocked in the same way in the future?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am extremely grateful to my hon. Friend for bringing her clinical expertise and experience to the Chamber and to this important debate. As for her precise questions about who did what and when, I hope she will understand that I have been working at pace on this report over the last few days; I have asked these questions myself, and I will update the House when I am in a position to do so.

Let me return the House’s attention to the expectation, not just moral but professional—in the light of the report and the evidence that it has produced—that clinicians and other medical professionals will act in accordance with these recommendations. That will mean that when regulators examine the conduct of medical professionals, they do so against this backdrop and in the context of these expectations. If there are people who are operating under the misguided apprehension that their ideology trumps the evidence, I fully expect the regulators to crack down on that.

Several hon. Members:

rose—

Photo of Rosie Winterton Rosie Winterton Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. I am anxious to ensure that everyone gets in, because this is an important statement, but we also need to ensure that the questions are brief so that the Secretary of State can give brief responses. We have a big debate ahead of us on the Safety of Rwanda (Asylum and Immigration) Bill, followed by another debate on the hospice movement, and I am sure that many Members will want to participate in those as well. Perhaps they will bear that in mind when framing their questions.

Photo of Rosie Duffield Rosie Duffield Llafur, Canterbury

Let me first thank the Secretary of State for her thoughtful and considered statement on the Cass review, and especially for mentioning the journalists, such as my friend Hannah Barnes, who blew the whistle on the Tavistock clinic. As she has said, those who have raised this issue over the last few years, desperately concerned about the safeguarding of vulnerable children and young people—too young to make life-changing decisions—are owed a heartfelt apology for being no-platformed, ghosted, sidelined and disciplined at the behest of a few extreme groups of activists, some within political parties. Does she agree that these academics, politicians, writers, psychologists and actors, along with any other people who have questioned the signing up of their workplaces to Stonewall law, have now been vindicated by Dr Cass’s expert review, and that they should be apologised to?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I come to the Dispatch Box with huge admiration for the hon. Lady for the commitment that she and other Labour Back Benchers have shown, in a culture and an atmosphere in which their views were demeaned and they were sneered at and castigated. Indeed, I hear rumours that efforts were made to remove certain Members from the party itself. This is the moment for apologies and for humility, but also for us to start a clean page and ensure that, when perfectly reasonable questions are asked about the medical treatment of our children, those questions are allowed to be asked in an atmosphere of respect and understanding, so that these vulnerable children and young people are looked after in a caring and careful way.

Photo of Miriam Cates Miriam Cates Ceidwadwyr, Penistone and Stocksbridge

I warmly welcome the Cass review and its findings, and the extraordinarily strong statement made by my right hon. Friend. I have no doubt that what happened at GIDS—the Gender Identity Development Service—will go down as one of the worst safeguarding and medical scandals of our generation. I pay tribute to the brave parents, including those in the Bayswater support group, who have been raising concerns for years about the ethics and the safety of putting vulnerable children on irreversible and unevidenced medical pathways with the aim of achieving something that can never be achieved, which is to change their sex. Those who spoke up for the interests of children and, frankly, for the interests of common sense were labelled bigots, transphobes and even fascists. Even after concerns were raised and Dr Cass had been commissioned, the Tavistock was allowed to continue to practise, which was a shocking suspension of the precautionary principle. This scandal happened because too many adults put their own desire for social approval above the safety of vulnerable children. How can we make sure that that does not happen again?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

As my hon. Friend was asking that question, there were people on the Opposition Benches tutting her. That shows that while some understand the need to keep the debate about the clinical needs of these children and compassion, there are still people on the Opposition Benches who do not get it. For example, in 2020 the deputy leader of the Labour party signed a charter describing bodies such as Woman’s Place UK, which, dare I say, campaigns for single-sex rape refuges—to which the House knows I have an enormous commitment—as “trans-exclusionist hate groups”. That sort of language needs to be apologised for, so that we can all move on. We expect clinicians and medical professionals to do the right thing by the Cass report, and by our children and young people. There needs to be some leadership from all of us in public life to ensure that we set the right example to those people.

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Scotland), Liberal Democrat Spokesperson (Women and Equalities), Liberal Democrat Spokesperson (Cabinet Office)

At its heart, the Cass report sadly highlights the low standard of care for our young people who were caught up in a toxic debate. There were long waiting lists, and the debate seeped into the staffing of the medical profession. Does the Secretary of State agree that we have to look at the wellbeing of our children holistically? How will she overcome the recruitment and staffing problems that have been created by this toxic debate?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank the hon. Lady, who has an exemplary record of campaigning on this issue. This comes down to the very careful review by Dr Cass. We have to get away from the idea that if a child presents with gender distress, that is the only part of their health that we should care about and look into. We have to look across the board to ensure that we look after every single part of them and do not assume that medical pathways are the only and inevitable pathways for them. One of the concerns raised in the report is that the terrible mental health issues that many children and young people were suffering from were not being looked after. People were just put on drugs and expected to get on with it. That is wrong, and we are determined to change it.

Photo of Paul Bristow Paul Bristow Ceidwadwyr, Peterborough

What was the Secretary of State’s reaction to the news that almost all gender clinics refused to co-operate with the Cass review? Does she agree that this is too important an issue for a circle-the-wagons attitude? What can she do to ensure that Government guidance is followed to the letter, and in spirit, when we tackle a gender ideology that seems to be running rampant through our public institutions?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

This is not about my emotions, but I can tell my hon. Friend that I was disgusted and angry. What is more, this is about being able to have conversations in our public space. For example, if our public institutions—whether it is the NHS, schools or whatever—are asked to respond to a thoughtful and careful review such as the Cass report, they must do so, because this information does not belong to them; it belongs to their patients, to future patients—because we want to shape services to help them—and to us as a nation. I welcome such institutions’ about-turn in deciding that they will provide the data. I am pleased that has happened, but my goodness me, I wish they had done it earlier.

Photo of Dawn Butler Dawn Butler Llafur, Brent Central

All trans children and young people deserve access to high-quality and timely healthcare and support. Around 100 studies have not been included in the Cass report, and we need to know why.[Official Report, 22 April 2024; Vol. 748, c. 663.] (Correction) The Secretary of State is obviously not concerned about the way that the Cass report has been used to perpetuate a broader hostile environment towards trans people in the UK—a hostile environment created in part by the Government’s delay in reforming the Gender Recognition Act 2004. Misrepresenting the report, and the high-and-mighty attitude from the Secretary of State, helps no one. Will she commit to the extra funding needed to help young people have a holistic approach to their healthcare pathway?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am not clear whether the hon. Lady supports the report or is castigating it; I have no idea whether she supports it or not. We are trying to use the evidence in this very thorough and thoughtful review, in the words of her Front-Bench spokesman, to help clinicians treat our young people and children in a compassionate, caring way. I have noticed, and have had it reported to me by others who have been watching, that certain campaigners are trying to build up a head of steam to say that the report is somehow flawed. It is not. This is superb evidence, and the NHS has assured us that it will act on it.

Photo of Jason McCartney Jason McCartney Ceidwadwyr, Colne Valley

The Cass review highlights the deterioration of mental health in young people. It particularly highlights the impact of social media, which puts awful pressures on young people. The mental health crisis obviously affects both boys and girls, but as the Secretary of State highlighted earlier, it particularly affects girls and young women. Will she continue to turbocharge child and adolescent mental health services’ crisis teams, and give them the resources that they desperately need to support our young people?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend for his question. We want to not just help with crisis support, but prevent our young people from getting into a position of crisis in the first place, so we are rolling out mental health support teams, ahead of our schedule, across schools. That is a really important piece of work that will help 44% of the student population, but we want to go even further. In the 12-month period ending in March 2021, we increased the number of children and young people aged under 18 who received NHS-funded mental health services to some 758,000.[Official Report, 13 May 2024; Vol. 750, c. 2WC.] (Correction) Of course, we want that support to be there in the community, but importantly we also want to help clinicians to understand that this is just one of several sets of conditions that they should have confidence to work on, in order to look after the child holistically.

Photo of Sammy Wilson Sammy Wilson Shadow DUP Spokesperson (Treasury), Shadow DUP Spokesperson (Work and Pensions), Shadow DUP Spokesperson (Brexit)

Given the vile campaigns directed towards anyone who disagrees with the transgender lobby, we should congratulate Dr Cass and her team on having the courage to write their report, and the Secretary of State on her robust defence of it. In the light of the report, and given that it seems that the transgender lobby has infiltrated the NHS in England, what steps is she taking to purge that lobby from the NHS? What discussions has she had with Ministers in Northern Ireland, Scotland and Wales to ensure that the same policies and practices are not carried out in the public and private sectors there?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

The reason why I am able to be so robust on this issue is that I believe in it; on that, I may be different from others. The challenge that the right hon. Gentleman rightly puts forward is that we have to ensure that NHS England acts as an organisation, but also at the individual and local levels, to implement the reforms that the report recommends. I want to be fair to clinicians, medical professionals, managers and others who very much support the review. I want to support them in taking up the recommendations. What individual clinicians may or may not have done in the past will be a matter for both NHS England and the regulators going forward. The moral and professional expectation is that in future, clinicians, medical professionals and all of us will respect the evidence and the recommendations of this important report.

Photo of Angela Richardson Angela Richardson Deputy Chair, Conservative Party

I would like to put on the record my thanks to Dr Hilary Cass for her thoughtful and comprehensive review. Does my right hon. Friend agree that those of us across this House who, for the past few years, have been calling for a pause on the ban on conversion therapy while we wait for Cass, because of concerns not with the L, G or B, but the T element of the ban on LGBT conversion therapy, have been completely vindicated in that call?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend sincerely for her help in raising these difficult questions and for doing so, as she has just demonstrated, in a thoughtful and careful manner. I know that she shares my concern that the children and young people at the heart of this should be our focus. We need to build the system around them, rather than them being slotted into the system, as has happened in the past.

On conversion therapy—again, I am being very mindful of the sensitivities of this—we are committed to supporting all victims of conversion practices, but we want to avoid any unintended consequences and ensure that the draft Bill takes account of the independent Cass review. That is why my Cabinet counterpart, the Minister for Women and Equalities, is leading the work in this area. We are very much considering this complex issue as part of our approach to this sensitive and important matter.

Photo of Tonia Antoniazzi Tonia Antoniazzi Opposition Whip (Commons)

The starting point of all modern medicine must be robust and reliable—in fact, rigorous—evidence. Back in 2017, I tabled a written question at the request of a trans constituent who was concerned that many adults and young people were putting themselves through a process that was not the right one for them. That was in 2017, and we still do not have much better data, but the data is the most important thing; it informs everything.

There has been a chilling effect in this Chamber, and on social media, on people who have spoken out, and who have asked questions like that—questions that we ask for reasons to do with everyday healthcare, which we have denied, and the Government have denied, to the children in our care. My hon. Friend Wes Streeting has been fantastic; he has shown great maturity and reflection in his comments in the Chamber and in the media, and so has the Secretary of State, but as someone who has been at the other end of this, I say: please, Secretary of State, let us get the tone of this debate right, and move forward. The Cass report is a great thing, and we have to work with it to deliver the best outcomes for the children in our care.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

Again, I approach the Dispatch Box with humility because I know about the journey that the hon. Lady has been on, and about the debates and questions that she has brought forward, not just on behalf of the constituent that she mentions, but on the wider issue of the treatment of women in healthcare and in other parts of public life. I very much want us to view the future as a clean sheet, so that we can build services around children, rather than expecting them to slot into services for the convenience of arguments that were put forward in the past.

However, we have to acknowledge that this has been such a long and toxic debate that there will be people who want answers. I appreciate the fact that Wes Streeting has walked back some of his comments, but it is important that we acknowledge the toxicity, so that we can move on and achieve exactly what the hon. Lady and I, and others around the Chamber, seek. [Interruption.] Interestingly, Opposition Members are chuntering from sedentary positions. I think that we can make a real change, but a little less sniping from the sidelines and a little more constructive work is needed.

Photo of Nicholas Fletcher Nicholas Fletcher Ceidwadwyr, Don Valley

I have called out this ideology locally, and here in Westminster with colleagues, at every opportunity available to me. At last, it appears that the world is waking up to this issue. Sadly, we know of at least 9,000 children who have been affected by this scandal and possibly damaged for life, so first I ask the Secretary of State whether she will establish a public inquiry into this issue.

Secondly, alongside reforms to the NHS, we must re-establish safeguarding in schools. Will the Secretary of State liaise with her Education colleagues to fix our statutory safeguarding guidance keeping children safe in education? It currently downplays the risk factor around a child identifying as trans; that must be addressed.

Finally, I believe that there are many bad actors who have peddled this nonsense, clearly knowing what they were doing while destroying our young people’s lives. If there is any justice, those individuals should feel the full weight of the law. I hope that they are quaking in their boots. They ought to be.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend for his powerful question. I am going to deal, if I may, with his point about a public inquiry, because I know that there are some who are asking whether that would be appropriate. Will my hon. Friend take it from me that, at the moment—bearing in mind that the report landed less than a week ago—I am determined to drive forward the actions that are needed on the ground to help children and young people? We have had a four-year review into this—Dr Cass has gathered a great deal of evidence and it is a very thorough review—and so, for the moment, I want to concentrate on implementing the recommendations and on ensuring that the services are brought up to the standards that my hon. Friend rightly understands.

On my hon. Friend’s second point, of course I will liaise with my colleagues in the Department for Education. This is about helping all public sector professionals to ensure that they are acting on the evidence, as set out in the Cass review, for the sake of our children and young people.

Photo of Joanna Cherry Joanna Cherry Shadow SNP Spokesperson (Justice and Home Affairs), Chair, Human Rights (Joint Committee), Chair, Human Rights (Joint Committee)

I warmly welcome this statement; that is not something that the Secretary of State will often hear from me. As she said, the Cass report has vindicated the concerns of many whistleblowers, including feminists and LGB activists, who warned of the consequences for children of unevidenced medical interventions and the ideological capture of the NHS. For doing so, we—because I was part of this—were defamed and hounded by organisations that many of us had formerly supported, like Stonewall, Mermaids, PinkNews, which I had to sue for defamation, and the misnamed Equality Network in Scotland. To their shame, Members of this House and Members of the other place joined in with that bullying and group-think.

While I hear what the Secretary of State has to say about a public inquiry, and about her immediate focus being on implementing the recommendations, it seems to me that we do need a public inquiry into how this institutional capture happened in our public bodies—as we all know, it is not just the NHS—because we need to make sure that never again do ideologues of any sort, or science deniers, take hold of our public institutions. When the Secretary of State is done with implementing the recommendations, or as she is doing that, will she support the movement for a public inquiry into these matters?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am conscious that I have just answered that, but may I put on the record my thanks and respect for everything that the hon. and learned Lady has done in this field? She has at times had to walk a very, very lonely path, and I find it extraordinary that parliamentarians—who are elected to represent the best interests of our constituents, and indeed of our countries—would find themselves under that sort of pressure for simply stating biological fact. I hope that the hon. and learned Lady will be working with me to ensure that the recommendations in the Cass review are applied not just in England but in Scotland, in Wales and in Northern Ireland.

Photo of Steve Double Steve Double Ceidwadwyr, St Austell and Newquay

I very much welcome this report and the strong statement by the Secretary of State in response to it. If there is one thing that should be above party politics, above political ideology, and above cultural trends or virtue signalling, it is the welfare of our young people, and this report lays bare that, sadly, that is exactly what has not been happening. This ideology has not only captured part of our NHS; it is found in many of our public sector institutions. I ask the Secretary of State, who has clearly taken a strong leadership position on the matter today, whether she will ensure that the findings of this report are implemented across Government—in education, local government, social services, and in our police force—to ensure that this can never happen again?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

This report sets out the evidence, which was not there before. It has taken four long years of very hard work to gather that evidence, and I hope and expect that the health sector will implement these recommendations. I also hope we can have a conversation about our wider public space, and I was very pleased to read the article by my right hon. Friend the Minister for Women and Equalities over the weekend. We have to de-politicise the public space and ensure that this evidence is applied across the board for the health of all our constituents and our country.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown

I welcome any research, and this report moves the debate forward. My reading is that Cass says there is a toxic debate on all sides, and that there are particularly nasty and vicious people on all sides. I have had posters put outside my house with rude words on them, etc, and it has happened on all sides. That is what Cass says—that it is unhelpful.

Cass says there seems to be little evidence that large numbers of people feel either regret or success, that there is poor evidence of effectiveness, and that there needs to be more evidence on the usefulness of social transition. I read it as saying that there needs to be an awful lot more evidence, but Cass is clear that young people should not be denied access to healthcare if they are trans; in fact, they should have more healthcare and more pathways. Will the Minister agree to fund that research? We should not get evidence from just adult services. We need proper longitudinal studies that mean we have an evidence base. Will the Government support a Cass-compliant amendment to my Conversion Practices (Prohibition) Bill that I believe can square this circle?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am sorry, but I think there is a certain amount of disbelief in the Chamber. I cannot be the only one who remembers the debate on the Gender Recognition Reform (Scotland) Bill in January 2023 when the hon. Gentleman not only tried to shout down female Opposition colleagues but felt so exercised that he crossed the Floor of the House to sit next to my hon. Friend Miriam Cates. I remember how Conservative Members were genuinely surprised that a Member of Parliament would think it appropriate to behave in that way when debating a subject that we are entitled to, and should feel free to, debate. I am sorry to hear that the hon. Gentleman suffered the abuse that he describes, but setting a good example starts at home. I hope he will never again behave as he did in the Chamber that day, because that is how we sort out the toxicity of this debate.

Photo of Douglas Ross Douglas Ross Ceidwadwyr, Moray

The Scottish Government’s response to the Cass review has been one of deafening silence. In fact, SNP Ministers have buried their heads in the sand and said nothing proactively about the review or its conclusions and recommendations. Indeed, the Scottish Conservatives’ request to have a statement in the Scottish Parliament on the Cass review has so far been refused by the SNP-Green Government, so I welcome the opportunity to speak about it here in the UK Parliament.

In her statement, the Secretary of State mentioned NHS England’s recent decision to end the routine prescription of puberty blockers to children. However, they are still available in Scotland. What discussions have there been on this issue, if any, between Scottish Government Ministers and the UK Government, or indeed between officials in NHS Scotland and NHS England?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend for his careful and considered question. I very much hope that the Scottish National party Government will look at the evidence very carefully and find the recommendations to their liking. It is to NHS England’s credit that it has acted so promptly, and I would hope and expect that the devolved nations, let by the Scottish National party and the Welsh Labour party, will follow with similar speed.

As I have had to say, because it is in line with the atmosphere in which clinicians are having to operate, the Hate Crime and Public Order (Scotland) Act 2021, brought forward by the Scottish National party Government and supported by Scottish Labour, cannot help the considered debate that we wish to have about this very complex subject, and I encourage them to look at that as part of their overall approach.

Photo of Emma Hardy Emma Hardy Shadow Minister (Flooding, Oceans and Coastal Communities)

I welcome the Cass review and its recommendations. Mistakes have been made that must never happen again, but the polarised public debate that she mentions reflects badly on this House. Does the Minister agree that making jokes about trans people and trans children is cruel, cheapens the debate and moves the focus away from ensuring that all our young people get the help they need when they need it?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

True leadership is not just about being careful with the words we use. I will not recite the many words that other Labour Members have used about trans issues. They say, for example, that it is factually inaccurate to say that only women have a cervix—[Interruption.] I am not naming them, but that seems an extraordinary things for a Labour Member to say. [Interruption.] They do not like to hear their words repeated back to them, but I will resist that temptation and instead focus on the application of policy.

Trans prisoners, including those who are fully intact and have been convicted of serious sexual offences, are demanding to be held in prisons that match their chosen gender. This Government, including me and many of my predecessors as Prisons Minister, set clear rules to ensure that situations such as the Karen White case are not repeated, so it was very troubling that Opposition Members did not appear to have the same concerns when it came to the placing of a trans double rapist, Isla Bryson, in Scotland. [Interruption.] I am being told that it is not true but, if Opposition Members want to factcheck, apparently it was the deputy leader of the Labour party who said that it does not matter.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

Although I would like to believe that many of these problems will be resolved by guidance and by changing the administrative rules, and things of that kind, I fear that the real problem is much deeper. It is about the manner in which, over the last generation, we have introduced legislation that has facilitated these arrangements. I am glad that the Government have passed the Online Safety Act 2023 to deal with the platforms on which a lot of this stuff has been spuriously put out by people with absolutely no moral compass.

I thank the Secretary of State for what she has said this afternoon, and for the robust and extremely effective manner in which she has said it, but please do not believe that this will be resolved just by changes to administrative rules. This is about a moral compass and telling the truth. The legislation, whether it is the Equality Act 2010, human rights law or whatever else it might be, will need to be changed.

Photo of Rosie Winterton Rosie Winterton Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. I want to get everyone in, but we really cannot have mini-speeches. We need questions that the Secretary of State can answer briefly.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

The brevity of my answer demonstrates my respect for the observations and experience of my hon. Friend Sir William Cash. I completely agree with him, and I will enjoy working with him on this.

Photo of Neale Hanvey Neale Hanvey Alba, Kirkcaldy and Cowdenbeath

I thank the Secretary of State for her very important statement. I welcome every word of it, just as I welcome the final report of the Cass review. I thank Dr Hilary Cass for her outstanding work in lifting the lid on this dangerous ideology and its impact on predominantly young LGB people, and other gender non-conforming young people.

The Secretary of State made an important point about the insinuation of gender ideology and its impact on the health service. As other Members have said, we know that gender ideology has insinuated itself into many of our public bodies and into debate in this place. Pieces of legislation are being proposed in this place that would enforce the very conditions in the Cass report, where gender non-conforming young people are denied proper psychological and psychosocial support to come to a reasonable discussion and end point. What support will the Secretary of State provide to have that conversation and to weed out this ideology elsewhere?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank the hon. Gentleman for his advocacy on this issue. I very much hope that all Members will be able to use the evidence produced in this review and report in future debates about legislation so that we can all make informed and correct decisions.

Photo of Lia Nici Lia Nici Ceidwadwyr, Great Grimsby

Let’s be honest, Secretary of State, this excellent review exposes institutionalised grooming and abuse by so-called “professional” medical people. What is she going to do to make sure that people pushing this from day one are, as a minimum, now going to be on the sex offenders list and taken off being able to practise as medical people?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend and near neighbour for that. She is right, as is my hon. Friend Sir William Cash, to emphasise that this is about not just the debate within the NHS, but what happens online. I know that parents of children affected by this are very aware of the online “grooming”, as they describe it, of children on social media. I do not want to trespass for the time being on the regulators—we have already had some constructive conversations with them—but the will of the House is clear that we expect the report to be followed and clinicians to act on the basis of that evidence.

Photo of Marsha de Cordova Marsha de Cordova Llafur, Battersea

Let me start by saying that I welcome the Cass review’s findings, which make it clear that clinical services must be led by good-quality, robust evidence and highlight the lack and the poor quality of data. We all know the important role that data plays in delivering for patients. So does the Secretary of State agree that the review of adult gender services should take into account the number of patients with mental health challenges, such as depression, anxiety, autism, self-harm, eating disorders and many others? What additional resources will be put in place for mental health provision?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank the hon. Lady for her thoughtful question, because she rightly lists some of the mental health conditions that both Dr Cass and professionals in this area have realised can be part of the complex needs of children and young people who are asking questions of their identity and about their path in life. On funding, the financial value of the contract last year with the Tavistock was £9.3 million, but for this financial year NHS England has committed some £17.1 million for the two new hubs for gender services. Of course, they will keep this under review as we build up the services across the country in the ways envisaged in the report.

Photo of Richard Fuller Richard Fuller Ceidwadwyr, North East Bedfordshire

Let me add my thanks to Dr Hilary Cass for her review. Having listened to this Secretary of State today, I am confident that young people in this situation are in safe hands as she implements the recommendations. However, I wish to ask her about accountability, because what we have seen in the NHS with previous scandals, be it the contaminated blood scandal or Mid Staffordshire, is that accountability is a little slippery. Accountability is not just about lessons being learnt; it is about people being held to account for what they have done. So will my right hon. Friend be looking at ways in which there is room for people to be struck off if found to be wrong, for managers to be sacked and, in certain circumstances, for legal action to be taken?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I completely understand my hon. Friend’s desire for accountability. I just remind us all that some clinicians have acted in a morally exemplary way, trying to blow the whistle on practices they observe. He and I, and, I hope, others, want to ensure that clinicians who have not acted in accordance with their professional duties are held to account. As I say, ongoing conversations are taking place with the independent regulators, but I suspect that they have very much understood the way in which the House is viewing this and the seriousness with which we view clinicians who have not abided by their professional duties in this regard.

Photo of Kim Johnson Kim Johnson Llafur, Liverpool, Riverside

Many of the Cass review recommendations are to be welcomed, but there has been some dangerous misinterpretation of some of the recommendations in public discourse and, crucially, in NHS England’s response to the recommendations for transitional services for 17 to 25-year-olds. So will the Minister join me in challenging the NHS specialised commissioning team on its immediate limiting of access to support for 17-year-olds, including with the cancellation of appointments for some who have waited years, and in calling on it to immediately reinstate access while it reviews next steps?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I hope the hon. Lady will forgive me if I have misunderstood her question, but I think she is referring to the decision that NHS England will prevent under-18s from accessing adult gender services. A consultation has just closed and we are looking at the results of that, but I am very sensitive to the needs of young people within that 17-to-25 cohort for whom the “cliff edge”, as it has been described to me, of moving from children’s services to adult services may not be in their best interests. I promise that that is very much the focus of my work on this in the weeks ahead.

Photo of Julie Marson Julie Marson Ceidwadwyr, Hertford and Stortford

My experience of speaking to my constituents on this subject has been characterised by fear—it is often the fear of mothers about their daughters, the fear of what is happening to their children and the fear of speaking out because of the group-think and the toxicity of the debate. Does my right hon. Friend agree that Dr Cass’s extensive, evidence-based report should mark an absolute turning point, in ensuring that we spearhead our approach to this debate by putting children first and being non-ideological in all areas—across Government, in all Departments, not just the NHS, in education and in our public bodies?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend sincerely for that. Again, she articulates the concerns of many families where a teenager or young person may be suffering complex needs and are asking questions of themselves and their place in society. We must treat not just the child or young person, but the family with care and respect, trying to support them to get to the right place for the child.

Photo of Chi Onwurah Chi Onwurah Shadow Minister (Business, Energy and Industrial Strategy), Shadow Minister (Science, Research and Innovation)

Some constituents who have contacted me see in the Cass report a vindication of their long-held views on sex and gender following years of abuse, sometimes violent. Others who have contacted me fear that the Cass review represents an attack on their very existence as trans people and fear the abuse to come. Will the Secretary of State set out that she opposes utterly the toxification and politicisation of questions of sex and gender? Will she also set out that she will collect the additional evidence that the Cass review calls for, without which there cannot be an evidence-based approach? Will she also set out that she will put in place the resources our young people need in terms of healthcare to ensure that they receive the healthcare appropriate to them?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank the hon. Lady for giving me the opportunity to make it clear again that this report is about gathering the evidence to help support our children and young people to the best care they can have. For a very small number that may well be a medical pathway, but for the overwhelming majority we know from Dr Cass’s report that there may be other ways in which they can be best supported and looked after. I do not want anyone to walk away from this debate thinking that this is somehow a report about those adults who have made that decision of their own free will and are living their lives as freely as we all want them to—it is not. It is about the healthcare and emotional care and support that we give to young people and their families, and the professional confidence we give to clinicians to ensure that we get to the right place for each and every individual child.

Photo of Anna Firth Anna Firth Ceidwadwyr, Southend West

I welcome the Secretary of State’s powerful statement and the Cass report. However, we have to acknowledge that the report would not have been commissioned without this Government, with the support of some other parties. So many Opposition Members just stayed silent and thought the report was pretty much a waste of time, and to see the lack of any appreciation of that today is shocking and shameful.

On the timetable to enact the wider findings of the Cass report, I am grateful for what the Secretary of State said about meeting the GMC over the weekend, but there is work to be done. Secondly and really concerningly, what steps are—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker and Chairman of Ways and Means, Chair, Standing Orders Committee (Commons), Chair, Standing Orders Committee (Commons), Chair, Parliamentary Works Estimates Commission, Chair, Parliamentary Works Estimates Commission

Order. I am sure the hon. Lady does not mean “secondly”, because she is not making a speech. She has one question to ask, and I would be grateful if she could ask it.

Photo of Anna Firth Anna Firth Ceidwadwyr, Southend West

What are we going to do to provide emotional and psychological support for those who have already undergone this treatment with irrevocable consequences?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

My hon. Friend’s observations about Members from other parts of the Chamber and their response to this are well made, frankly. [Interruption.] Gosh, I am being told they are not true. Crikey, Opposition Members may have just opened up a Pandora’s box. On my hon. Friend’s point about supporting people who have gone through the process and are trying to detransition, she is absolutely right that they need particular care. I am actively looking into what NHS England needs to provide to look after the very complex needs that such people have.

Photo of Ben Bradshaw Ben Bradshaw Llafur, Exeter

Has the Secretary of State seen today’s very sad interview with Judge Victoria McCloud, Britain’s only senior transgender judge, who has been driven from her job because of anti-trans hate, particularly the trend among some politicians and opinion formers to describe being transgender as “an ideology”? The Secretary of State has used the term “ideology”, as have a number of her colleagues, during this statement. For the benefit of the House and trans people, will she clarify that she does not believe that being transgender is “an ideology”?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I genuinely thank the right hon. Gentleman for giving me the chance to re-emphasise that. When I have talked about ideology, it is the ideology influencing or making assumptions about the provision of services for any child or young person who is questioning their place, sexuality, identity or future path in life. The ideology is the one that influenced the services that Dr Cass has set out so very well. Of course, if an adult chooses to live their life as a transgender adult then they must do so freely, and, I would hope, with compassion and understanding from all of us. By the way, I have been talking about this for many years; when I was Minister for Women, I talked about this subject. We must deal with this issue in a caring and careful way, and that is what Dr Cass emphasises in her report.

Photo of Robin Millar Robin Millar Ceidwadwyr, Aberconwy

I welcome this statement. The Cass report highlights the area of prescribing untested and irreversible drugs as puberty blockers to young people, but in Wales the pathway for young people diagnosed with gender dysphoria includes referral to gender services in England. The Cass report also warns against teachers being forced into making premature and effectively clinical decisions about affirmation, such as social transitioning, and yet that is implicit throughout the Welsh Government’s LGBTQ+ action plan and their compulsory relationships and sexuality education curriculum. Does the Secretary of State agree that these findings have relevance for the safeguarding of children in England and Wales? Does she agree that parents, teachers and health workers across England and Wales can expect politicians to take heed of these findings?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I very much agree with my hon. Friend. He is always very good at exposing the differences in treatment that patients in Wales receive compared with those in England. Given that the leader of the Labour party has said that Wales is the “blueprint” for how it plans to run the NHS in England, I hope and expect that the Labour party will be true to its word and the Labour-run NHS in Wales will be announcing its immediate adoption of these recommendations, as well as the transformation to services that we in England are already undertaking.

Photo of Stella Creasy Stella Creasy Labour/Co-operative, Walthamstow

Many of us recognise the value of the Cass report, as my hon. Friend Lloyd Russell-Moyle set out, in its call for evidence and a thoughtful approach, and its recognition that the collapse of child and adolescent mental health services has contributed to the difficulties in children accessing services. However, I stand here today with terrified constituents who are part of the backlog. I dare say that thousands of those children have been watching this debate with their families and are frightened to hear the heat, not light. The Secretary of State has a brief in front of her, so can I ask her a practical question for my constituents who do not understand what this will mean for waiting times and delays? She said that she was not putting any new money into the service but funds were being reprioritised. In practical terms, what will that mean for those young people who are trying to navigate what is happening to them, who need our support and care, not the derision of any political movement?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I refer the hon. Lady to the answer I gave earlier about funding. In relation to the waiting list, we have already removed the Tavistock as the single provider of these services. We have now set up two sets of services in highly respected—world-respected—children’s hospitals, and we will add more. Again, the issue goes back to giving GPs and other practitioners the confidence to look after these children as they would if they were presenting solely with, for example, ADHD symptoms or concerns about mental health. This is about saying that this issue is one part of the patient they must treat, not isolating and siloing it in the way that has happened historically.

Photo of Alexander Stafford Alexander Stafford Ceidwadwyr, Rother Valley

Providing hormone blockers to children is wrong; encouraging and giving cross-sex hormones to children is wrong; and encouraging breast binding for children is wrong. In the future, I believe we will look back on this scandal—and it is a scandal—with incredulity about how we did this to our children, especially our girls. We should all be embarrassed that this is the situation we are in. It is not just carrying on in our hospitals and the medical profession; this sort of ideology is going on in our schools. Does the Secretary of State share my concerns and those of my constituents, who have raised the issue with me in private because they cannot raise it publicly, that a school in Rother Valley is fundraising for Mermaids, a charity that is accused of encouraging young people to transition simply because they do not confirm to gender stereotypes, even though they are too young to understand the consequences? Does the Secretary of State share my belief that Mermaids and other such charities have no place in our schools, and no place to help to hinder our children?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend, and I will set out the practical and important steps NHS England has already taken, which I hope other parts of the United Kingdom will follow. NHS England has banned the prescription of puberty blockers for gender dysphoria to children under the age of 18. On the advice of Dr Cass, cross-sex hormones can be prescribed only with extreme caution for those aged 16 and older. No cross-sex hormones may be prescribed to those under 16 for gender dysphoria. There are medical caveats to that for other medical conditions, and we need to be very careful about unintended consequences, which is why this is such a complicated piece of work. We want to ensure that these drugs are prescribed to the right people, if they should be prescribed at all.

On my hon. Friend’s point about campaigning organisations, part of our collective frustration is that our public spaces have become politicised. I would say there is no space for that sort of campaign activity in any of our public institutions. I appreciate that a range of views must be represented. Young people must be helped to discover their path in life, their sexuality and all of the things that are such a wonderful part of growing up, but we have to do so in a way that is fair and rigorous, and does not give way against the evidence into the realms of ideology, which sadly we have seen in some instances.

Photo of Stephen Farry Stephen Farry Alliance, North Down

I welcome the Cass review. Its recommendations merit proper and full consideration. Dr Cass has called for young trans people, their families and clinicians to be treated with respect and compassion. Sadly, we have not seen that today in some of the comments and heckles that have been made during the statement. Will the Secretary of State commit to challenging the harmful culture of transphobia in the UK, which is growing, and that was challenged in 2022 when the Parliamentary Assembly of the Council of Europe placed the UK alongside Russia, Hungary and Turkey?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

If the hon. Gentleman wants to work constructively with me on ensuring that we deal with this report and the evidence in a caring and careful way, for the benefit not just of children and young people but of the wider trans community, I would welcome his support in so doing.

Photo of Zarah Sultana Zarah Sultana Llafur, Coventry South

Although I welcome the call from Dr Cass for all young people, including young trans people, to be

“treated with compassion and respect”,

I share concerns about important elements of the review, particularly given the context in which it was published. Last year, transphobic hate crimes hit a record high. A United Nations report noted deep concern about the increase in

“harassment, threats, and violence against LGBT people” in the UK, and blamed the toxic debate about sexual orientation and gender identity. Will the Minister join me in condemning the rise in transphobia, in acknowledging that trans rights are human rights, and in recognising that we will only deliver high-quality healthcare that everyone deserves when we respect the rights and dignity of all?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

Not only have I tried to espouse those principles in every ministerial role that I have held, but it is the guiding light of this Government to try to ensure that we get the right healthcare and support to patients as quickly as possible. We also want to ensure that we are treating not just the condition, but the patient as a whole. As some of the complexity of the debates that we had this afternoon shows, young people are at the very heart of this. I think this is the final question, Madam Deputy Speaker, so I will end with the young people that we are concerned about. [Interruption.] I am so sorry; I have one more question from Jim Shannon. The children and young people who are the focus of this report have to be, and will be, the focus of our work going forward. We want to get the right services to the right children at the right time.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

You are most kind, Madam Deputy Speaker. I know that I have now caught the Secretary of State’s eye.

May I thank the Secretary of State for her fortitude and determination, and Dr Cass for all her endeavours? Both ladies—honourable ladies, I believe—have been incredibly impressive and capable. We should be taking on board Dr Cass’s report in Northern Ireland. Indeed, I will make it my business to ensure that the Minister in Northern Ireland takes this in, so I shall be sending him a copy of the report. What help and support is available for all those patients who have been in the Tavistock since its inception? Importantly, what steps can be taken by the Government to stop this malpractice and to stop the movement of the vulnerable—some have called this tantamount to abuse—into privately funded abuse? How quickly can that protection be put in place?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

Let me offer the hon. Gentleman my sincere apologies; I am out of practice and should have known that his would be the last question.

I genuinely look forward to working with my Northern Irish counterparts on this, as we have already worked together on other matters. The hon. Gentleman makes a point about private practices. That is one area that I am working on at pace. What we do not want is to have any idea forming that somehow people can get round the strict rules that the NHS is setting the system to get these drugs to young people and children. I promise to come back and update the House when I have more news on that, but the hon. Gentleman is right to identify that issue. It shows the complexity of the matter and the real need for a very clear, detailed and principled approach to help reform our NHS so that we make it faster, simpler and fairer.