Contribution
It is a pleasure to serve under your chairship, Mr Mundell. I thank the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) of the Petitions Committee for the way in which he introduced the debate. In his usual style, he made sure that he had talked to a range of people and experts to inform this debate.
I want to start by recognising that the thousands of signatures on the petition show the real strength of feeling on this issue. I thank everyone for taking part. I am acutely conscious of the young people, their families and people in the Public Gallery today and outside who are paying close attention to this debate and what is being said. I hope to address all the issues that have been raised—I have kept notes and listened carefully—as I know people want to get this on the record. I will say now that I will not take any interventions; I will just set out where I think we are. If I do not answer particular questions, I will get back to people.
I want to assure colleagues and the signatories to the petition, particularly young people and their families, and those who are waiting for, have had or have been concerned about gender services, that this Government will always be led by science and not ideology. We are proceeding carefully in line with clinical advice and we will always put the interests of vulnerable children first, because their health and wellbeing are not negotiable. That is our position.
Let me start, briefly, with some of the context. In 2020, NHS England commissioned Dr Hilary Cass to undertake a review of NHS children and young people’s gender services. Like others, I am sure, I have taken time over the weekend to re-read her interim report and her full report; I commend both to people with an interest in the subject.
Dr Cass is one of the most pre-eminent clinicians in her field, and her review is the most definitive assessment of its kind. It laid bare the inadequacy of the now decommissioned Tavistock Gender Identity Development Service. The interim review and final report made it clear that we needed better data and a stronger evidence base to design the right services for children and young people presenting with questions around gender dysphoria or gender incongruence, given the poor evidence base for services and treatment against rapidly increasing and, as we have heard, changing demand.
Dr Cass recommended a new model of care based on holistic assessment and psychosocial support, with further research into puberty blockers, specifically where they are not provided in isolation. The Labour party in opposition welcomed her report and accepted her findings, and we continue to do so in government. Many of the recommendations in her report are being implemented, including opening new NHS children and young people’s gender services while building the evidence base in parallel through a national research programme.
As the hon. Member for Caithness, Sutherland and Easter Ross outlined, the rationale for the clinical trial is part of the recommendations to gather robust, contemporary and comparative evidence on the relative benefits and harms of puberty-suppressing treatments in children. That is how we can decide whether puberty suppression can be an option in NHS gender care in future.
The PATHWAYS trial has undergone thorough scientific, clinical, ethical and regulatory safeguards. Following academic peer review, it was supported by the independent National Institute for Health and Care Research funding committee. It was endorsed by a multidisciplinary and multi-agency national research oversight board, and was then subject to formal regulatory approvals via the Medicines and Healthcare products Regulatory Agency; the Health Research Authority, including a review by an independent research ethics committee; and finally, the Commission on Human Medicines, which made considered recommendations to the study team that were adopted in full.
As with all complex clinical trials, the top priority of each of those organisations is the safety of the trial participants. The MHRA in particular is maintaining a high level of scrutiny and taking a cautious and measured approach. Where appropriate, after initial approvals have been granted, there can be ongoing dialogue between the sponsors of clinical trials and the MHRA. That is part of the process—I want to stress that point.
The MHRA has raised concerns relating to some elements of the trial design, and those questions obviously need answering. Rigorous and constructive discussions are accordingly under way between the MHRA and the trial sponsor.