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Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I beg to move,
That this House has considered the provision of healthcare for transgender people.
It is a pleasure to serve under your chairmanship, Mr Turner. This debate is about healthcare for trans adults. I know that a lot has been said in this House in recent weeks about care for young people questioning their gender identity, and particularly about the recent announcement of a trial of puberty blockers. I do not wish to repeat that debate here, other than to say that I welcome the fact that the trial is going ahead to ensure we can get the evidence that we need.
I want to begin with the experience of one of my constituents, because this debate must be about real people, not headlines in The Times or the Daily Mail, not culture war soundbites, not the opinions of Donald Trump or J. K. Rowling, and certainly not whatever bile is being pushed out by transphobic trolls on social media. This is about real people’s lives.
Earlier this year, my constituent, a trans woman, came to my surgery to share her experience of accessing healthcare locally. At her GP practice, she was told that she could not use the women’s toilets and must use the men’s instead, and she was repeatedly misgendered by staff. She faced difficulties simply getting her preferred name recorded correctly. On one occasion she was even told that she could not wait in the waiting room because she “scared other patients.”
My constituent is also struggling to access the gender-affirming care that she needs. There are no adult gender services in Birmingham, let alone in my constituency of North Warwickshire and Bedworth, meaning that she would have to travel to Nottingham for treatment. She is stuck on a waiting list with no idea when she will finally receive care. Because she cannot get NHS support, she is taking hormone replacement therapy on a private prescription and is understandably anxious about dosage and the lack of monitoring or regulation. She is not alone.
Emily Darlington (Milton Keynes Central) (Lab)
My hon. Friend is making a powerful speech and bringing the debate back to people, which is where it needs to be. I want to highlight a case in my constituency of a young transgender person who spent two years on the under-18s waiting list for an initial appointment. They have now aged out of that waiting list and potentially have a six-year wait, meaning that when they are able to speak to a doctor or a health professional it will have been eight years. Their parents approached me to tell me how much that is damaging their young one.
Karl Turner (in the Chair)
Order. I remind Members that interventions need to be very short. Lots of Members want to take part in this debate and long interventions eat into the time for speeches.
Rachel Taylor
I thank my hon. Friend for sharing that experience. It reflects the reality for many trans young people and adults in the UK: discrimination from healthcare professionals, waiting lists stretching over years, a complete lack of local provision and a reliance on less well-regulated private providers. That is the state of healthcare for trans people in Britain today. It is woeful and inadequate, and it is letting people down.
The consequences are serious. Almost one in four transgender people avoid going to the doctor altogether for fear of mistreatment. They delay cancer screenings and push aside chronic pain, and their health outcomes worsen as a result.
Rebecca Smith (South West Devon) (Con)
The NHS has finally issued a call for evidence regarding a clinical pathway for adults who wish to detransition. Does the hon. Lady agree that that is a welcome and long-overdue first step, and that the NHS must continue making serious efforts to improve care for detransitioners?
Rachel Taylor
As I welcome services for trans people, I also welcome services for those people who do not feel happy in the gender that they have acquired. That is only right, but we have to get all those services right.
Trans people are now seeing their health outcomes worsen. Waiting times for gender-affirming healthcare are nothing short of a national scandal. Across the UK as of March 2025, more than 48,000 trans adults remained on waiting lists for that care. We rightly debate NHS waiting lists in this place: a year for a hip replacement; months for cancer screening. Nobody finds those waits acceptable, but freedom of information requests reveal that the average wait for gender services is 12 years in England, two years in Wales, 41 years in Northern Ireland and a staggering 58 years in Scotland. At one Scottish clinic, the wait was three times longer than the average British life expectancy.
Graeme Downie (Dunfermline and Dollar) (Lab)
I thank my hon. Friend for highlighting the waits that transgender people face in Scotland, which are far too long. I recently met a group from the transgender community in Dunfermline who are concerned about their safety when they are out on the streets, whether going out on a Saturday night or doing anything else that they would like to. Does my hon. Friend agree that we must work with the police across the UK to make sure that transgender people feel safe on the streets?
Rachel Taylor
My hon. Friend is absolutely right. Trans people are fearing for their lives in my constituency, in his constituency and in many others up and down this country.
Let us imagine being told that the wait for a hip replacement or a cancer check was 224 years—it just would not happen. Some Members in this House might not want to hear it, but the reason that the NHS provides gender-affirming treatments—hormones, surgeries, and mental health and social support—is because they are proven to improve mental health, reduce gender dysphoria and significantly reduce depression, anxiety and suicidal thoughts.
Doing nothing is not a neutral act—doing nothing allows suffering to grow. The Women and Equalities Committee heard that directly earlier this year. To echo the findings of the Trevor Project’s 2024 report, LGBTQ+ young people’s suicides are preventable. Prevention means tackling discrimination, hostility and unaccepting environments. Safe, supportive, affirming care saves lives. One trans adult told the LGBT Foundation:
“The only effective treatment for gender dysphoria is transition and leaving this untreated is killing people.”
Rachel Taylor
I will make some progress, if I may. I am part-way through something that a trans person said, so it is not an appropriate time to intervene. They went on to say:
“I have personally used alcohol, cannabis, cocaine and self-harm to survive the last year and a half since referral and I have now been told I will have to wait several more months because of the backlog.”
Jim Shannon
I am reminded of last year when a mother came to me back home. Her son wanted to transition. The mother was under real pressure, as was the young boy. We tried to help as much as we could through the health system back in Northern Ireland. Does the hon. Lady agree that there is a journey not only for the young person who wants to transition, but for their parents? Everyone needs support to get them through that difficult transition.
Rachel Taylor
I thank the hon. Gentleman for his helpful contribution. Of course, parents need help and support through this process.
In 2022, a coroner ruled that a 20-year-old trans woman had died in part because of delays in accessing gender-affirming care after two and a half years on a waiting list. Trans people also struggle disproportionately with general healthcare. A third of trans and non-binary people, rising to almost half among people of colour, received no NHS or private support during pregnancy, compared with just 2.4% of cis women. Nearly one in three trans and non-binary birthing parents said that they were not treated with dignity and respect in labour, compared with just 2% of cis women.
According to TransActual, 60% of trans people surveyed had been refused care because they were trans. Hundreds reported that their GP refused to prescribe hormones, even when they had been recommended by NHS gender clinics. Participation in cervical screening is also significantly lower, with trans and non-binary people estimated to be up to 37% less likely to be up to date with appointments. This Labour Government are the right Government at the right time to tackle these issues.
I congratulate the Minister and the Secretary of State on the HIV action plan that was announced this month. I remember vividly the stigma and shame of an HIV diagnosis in the ’80s and ’90s, which often led to suicide, as the alternative was a death sentence and a life spent facing discrimination and abuse. This HIV strategy is groundbreaking and sets us on the right path to end new HIV transmissions. I applaud its commitment to ensuring that all prevention efforts target underserved populations, including trans people.
The Government pledged in their manifesto to ensure that trans people receive the healthcare and support they need. I welcome the review being led by Dr David Levy into adult gender services, and I hope it will bring forward strong recommendations to cut waiting lists, expand access and deliver timely, appropriate and sensitive care. I know that trans people and LGBT organisations have been awaiting its publication, so I ask the Minister: when can we expect Dr Levy’s review to be published?
In April 2025, the Secretary of State also commissioned NHS England to undertake an LGBT+ health evidence review. That review seeks to identify the barriers to healthcare for all LGBT+ people, from examining the poor treatment of lesbian couples seeking IVF treatment to looking at insufficient mental health support for LGBT+ people. The review is highly anticipated by the whole community. Therefore, I ask the Minister: is Dr Brady’s review still due to conclude in January 2026, and when can the public and parliamentarians expect to see it?
Although I applaud the Government’s work to improve healthcare for transgender adults, I know that reviews alone will not fix the problem. We need to know that these reviews will be followed by action. I know that getting this right matters to the Government, so I ask the Minister: what steps will the Government take to reduce discrimination and transphobia in healthcare settings?
Will the Minister commit to mandatory training for clinicians on the respectful and appropriate treatment of trans patients? Will the Government commit to significant sustained investment in trans healthcare, with reducing waiting lists and expanding local provision as urgent priorities? We must build a healthcare system rooted in science, not stigma, and in compassion, not fear. We must decide whether we want to be a society that listens to people, supports them and gives them the tools to thrive.
There is one final point I would like to make. Those who know me will know that I first got involved in politics in the 1980s when Thatcher was introducing section 28. That policy was intended to make people like me feel shame about who we were, and to reverse the progress that previous generations had fought for. I got into politics to fight that cruel law and everything that it represented.
I am a gay woman who grew up in the ’80s, so I know what it feels like to be told, “It’s just a phase. Maybe you’ll grow out of it. Maybe it’s not really who you are. Maybe there’s just something wrong with you,” so believe me when I say that I have heard it all before. LGBT people have heard this all before. We know what bigotry is when we see it, and we know that bigotry is back. Let us make no mistake: the people who are organising against trans people now are no different from the people who campaigned for section 28. They want to present parts of our movement as a danger to society and push them to the margins. I will never let that happen.
To all those in this room and in this House who are totally convinced that trans people are not real, that they are making it up, that it is TikTok, Reddit or foreign TV that has turned them trans, that somehow this is some kind of new phenomenon, let me assure you all that I have had trans friends for as long as I have been out. Trans people have always and will always exist.
To all those in this room who used to say warm things about trans people back when it was popular to do so but who decided when the wind changed that they would blow in the other direction, and to the Conservatives who in 2018 introduced an LGBT action plan promising trans equality but who now are quite happy to laugh along with cruel mocking jokes about trans people in front of the mother of a murdered trans teenager, we see you, and much like history condemns section 28, history will condemn you too. Meet trans people, talk to them, understand what they are going through and believe them, then we can all stop fighting our toxic culture wars and get back to doing what we as lawmakers are elected to do: make things better for every single one of our constituents—not some of them, all of them.
Several hon. Members rose—
Karl Turner (in the Chair)
Order. I remind Members that they should bob if they wish to speak in this debate. I have to put on a time limit of three minutes for speeches.
Vikki Slade (Mid Dorset and North Poole) (LD)
It is a pleasure to serve with you in the Chair, Mr Turner. I thank the hon. Member for North Warwickshire and Bedworth (Rachel Taylor) for such a passionate, incredible speech. Although she focused on adults, I would like to talk more about young people.
I am not sure whether the recent outrage about the puberty blockers trial is a result of misunderstanding, or whether those who do not accept that trans people have a right to affirmative care are simply using it as another opportunity to cause distress and harm to young people who are already marginalised and deeply frightened about their future. I am going to be generous and say it is the former, and I will help by providing some clarity.
Puberty blockers have been used since the 1980s. Although in a small number of high-profile cases, an individual has transitioned back to the gender assigned at birth, the vast majority do not. An Australian study found that 5% ended up identifying with their sex assigned at birth, but only 1% of those did so after receiving puberty blockers or hormone replacement therapy. The others did so during their initial assessment at the clinic. That is significantly lower than the regret rate for breast implants, tattoos or any other change to someone’s body. Puberty blockers are not permanent; they are to delay puberty and pause development.
Imagine a young transgender child who starts to live as a boy as they end the primary phase of their education—taking part in boys’ sports and changing their name on documentation—then having to contend with breast growth and menstruation at school. Or think of a teenage trans girl, who is fully accepted by her friends, suddenly experiencing the growth of facial hair and a dropping voice, and waiting years for an appointment. Imagine how they feel sick, showering a body that physically repulses them, binding to ensure they pass among their friends, and hiding from any situation where they are exposed.
Children whose puberty is advancing too quickly can access these drugs, but trans children cannot. When the drugs were banned last year and the Government announced that there would be a trial, I thought that those who genuinely wanted fair and safe healthcare for trans children would have welcomed it. Instead, they described those children as guinea pigs. The trial must go ahead and needs to be expanded.
Tom Hayes (Bournemouth East) (Lab)
Trans healthcare is challenging to access and afford. Waiting lists are ludicrously long and treatment options are limited. There is a massive gap between the treatment that trans people need and what they are being offered. Does the hon. Member agree that, as we just heard from my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor), trans people are human beings who deserve to be treated as such, with equal access to healthcare?
Vikki Slade
I thank my neighbour for his intervention. Of course they are people; they are our friends, family and neighbours. Puberty blockers are of no use once someone reaches 16 or 17, as by that time the damage is done. The hon. Member for Sleaford and North Hykeham (Dr Johnson) may pull a strange face at me but, frankly, for those children the damage is often done. They have often attempted suicide multiple times and their lives have been damaged. All they want is access to the support, the hormones and the treatment that they should be entitled to. When they reach 17 years and nine months, however, they are transferred to adult services. In some cases, they have been waiting since they were 12 or 13, only to be told that the south-west of England is currently dealing with referrals from 2017. That is simply not acceptable. We know it is dangerous for people to wait long periods. Coroners repeatedly refer to long waiting lists in the context of trans people’s deaths.
In my last few seconds, I want to address shared care. A constituent of mine, a trans man who transitioned at about 18, has had NHS care in place for many years. He has now been told by his GP that they will not offer him shared care. He has been told that the practice has had a letter from the gender identity clinic saying that the practice does not have the systems, capacity or expertise in place to provide the level of monitoring and care. That is simply unacceptable. This is NHS care. My constituent has NHS prescriptions. Now his own GP says that they will not support him, despite being required to do so. I ask the Minister to look carefully at this issue to ensure that trans children get the services they need and trans adults continue to receive them.
Nadia Whittome (Nottingham East) (Lab)
It is a pleasure to serve under your chairship, Mr Turner. I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for securing this important debate and for all her work to champion trans rights in this place.
First, I want to speak about the delivery of general medical care to trans people and the discrimination they experience. Constituents have told me how unrelated health problems have been attributed to them being trans. One person described this as “exhausting and frightening”, stating that it discourages them from seeking help. Meanwhile, 14% of respondents to a survey by TransActual reported that they had been refused GP care on account of being trans. One trans man told the Nottingham Pastel Project that he had been turned away for a cervical smear and treatment for a urinary tract infection.
The second issue I want to raise is the difficulty of accessing gender-affirming care. Trans people will be the first to say that the delivery of gender-affirming care in this country is deeply flawed and in need of serious reform. Instead of taking their experiences as the starting point, discussions about trans healthcare have been rooted in transphobia, misinformation and moral panic. Meanwhile, waiting times for gender-affirming care stretch into years. One Nottingham resident said that they waited seven years for a diagnosis. Another has been waiting for an appointment with a gender identity clinic for five and a half years. Someone who joined the waiting list two years ago has been told to expect to wait a further four years.
Faced with an eight-year wait for gender-affirming surgery on the NHS, one trans person in my city worked two full-time jobs, sold their car and held fundraising events to cobble together £20,000 so they could have that surgery abroad. They are emphatic that it saved their life, but they should never have been forced to go through that ordeal just to access healthcare.
Reports of GPs denying gender-affirming care have increased dramatically. One constituent told me they had huge problems finding a private gender clinic with which their GP would do shared care, and that delayed their treatment by six months. Another Nottingham resident who was on testosterone for more than a decade has not received a single dose in 16 months because their GP has refused to prescribe it. I could go on and on with examples just from my city, and I have not even spoken about the appalling situation that trans people under 18 face.
It is clear that the Government must act, from increasing funding for gender-affirming healthcare to improving training for GPs, modernising assessment and treatment pathways and ensuring co-production of services with trans patients, because this is an emergency. Inadequate healthcare is ruining trans people’s physical health, their mental health and their lives. It cannot be allowed to continue.
Carla Denyer (Bristol Central) (Green)
It is a pleasure to serve with you in the chair, Mr Turner.
It is a pleasure to represent a constituency with a thriving trans community. Too often, however, when I hear from trans people who live in Bristol Central or their loved ones, it is because they are struggling to access healthcare. Whether they are stuck on a waiting list to access a gender identity clinic or whether they are a parent looking for support for their child who is questioning their gender, again and again, trans people are refused healthcare that they are entitled to.
Despite the invaluable work of organisations such as TransActual and Stonewall nationally, and Trans Pride Bristol and Trans Aid Bristol in my home city, investment is not being made in public services; instead, trans people find that their rights are sacrificed to the same culture war that scapegoats migrants and people of colour.
When I speak to young trans and gender-questioning people and their families, a major concern is the ban on puberty blockers. Many were heartbroken when the Labour Government made the Conservatives’ temporary ban permanent, rather than rolling it back. That forces young people to go through puberty in a body that does not match their gender, as we have heard. I strongly urge the Department of Health and Social Care to think again on the puberty blocker ban.
I welcome the announcement of the pathways trial, which will give some young people a route to access puberty blockers. I asked the Secretary of State a year ago to clarify the size of the trial, and he assured me in the main Chamber that it would be uncapped. Yet it turns out that the trial will allow just 226 young people to take part. Please will the Minister explain why the numbers were capped, contradicting what I was told in the Chamber last year? Will she also respond to concerns that young people are being pressured to take part in the research because it is the only way to access the care they need?
Healthcare is no better for trans adults. As we have heard, waiting lists for gender identity clinics are unmanageable, with an eight-year wait in the south-west. Coroners have repeatedly referenced the length of such waits following trans people’s deaths. As a result, more than half of trans people have used private healthcare, creating a two-tier system for a community that already faces economic disadvantage. While I am pleased that a pilot wellbeing programme will be introduced for those on the waiting list, that is no replacement for getting trans people the timely healthcare that they need.
Trans people face more barriers to accessing healthcare than I have time to cover in this speech, but I want to highlight that I have had plenty of casework about shared care agreements that have suddenly been stopped, even for people who had accessed healthcare successfully for years through their NHS GP. The Levy review on adult gender dysphoria services might cover some of the issues, but I hope that it will cover all of them. I would like to hear from the Minister when that review will be published, if possible.
Ms Stella Creasy (Walthamstow) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Turner. I think I speak for everyone in this Chamber when I say that it is a privilege to be in the room with my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor), and to hear her passion for this subject and her honesty about the impact. Too often, that voice is missing in our politics. Wherever we stand, I think people can recognise that.
I am so grateful for this debate, because in the time available to me, I want to highlight what we have been doing in Walthamstow on this issue. We were worried that we would never find allies for our work, and today is a reminder that we will, because the majority of people in this country understand a simple and decent point: trans people pay for the NHS too, and they should be entitled to services that suit their needs. The reality for that very vulnerable and small group within our society is that they are not getting the services they need. This is not just about gender-affirming healthcare; it is about healthcare across the piece. That is the challenge that we have been dealing with in Walthamstow.
I pay tribute to the members of my local trans community who have had the bravery to come forward and speak about their experiences. I will not name them because, sadly, we live in a world where people would demonise them simply for speaking up about the fact that, because they cannot access their local GP—particularly in shared care agreements, which many others have mentioned—they cannot access healthcare at all, even for other conditions. They might also have physical disabilities or attention deficit hyperactivity disorder, but they struggle to access services accordingly. No one can think that it is acceptable for a patient group in the NHS to be systematically excluded. I pay tribute to the North East London integrated care board, which has risen to the challenge and recognised the problem, and is now looking at how to resolve it.
I think we all recognise that shared care agreements are complicated, but the reality is that not every shared care agreement is refused. Not every person in my constituency with a referral from an NHS provider, let alone a private one, gets a doctor who says, “We do not cover that agreement”. Some in our local trans community are self-prescribing hormones and not getting the blood tests and monitoring that they need, and they face a delay in getting support. I want to put on the record that there have also been some very positive responses from my local GPs, but it is patchy.
In the time available to me, I make one simple plea to the Minister. It is great that we have the David Levy review, but I ask for the Minister’s help and support for my local clinicians. They are cutting through the heat in this debate and asking a simple question: how can we serve this local community better? How can we make services work better for them? I will stand up for the right of every single one of my constituents to get decent healthcare, but I ask the Minister to work with us to get it right on the ground.
Oliver Ryan (Burnley) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Turner. I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for securing this important debate. She is the champion we all deserve, and she almost brought me to tears with her passion in opening the debate. I commend her work and her advocacy. She is a modern-day LGBT icon, and I feel privileged to serve with her.
In a world that feels increasingly divided, debates like this matter because they force us to confront and test a simple but critical principle: the great, objective universality of our healthcare system—who gets access to healthcare, and who is treated? My gut, my politics and my experience as an LGBT person say everyone. I am sure that all Members present would agree that healthcare is not a privilege to be earned; it is a right grounded in dignity, compassion and evidence-based care. It is an inalienable right of every citizen of this country. To get to the nub of this debate, that means transgender people too, such as constituents who have come to see me in my surgeries. They are not asking for special treatment; they are asking for the same thing as any of us would expect: timely, safe and respectful healthcare, and dignity.
I am sorry to say, however, that healthcare falls short for them. Thousands of transgender people are waiting years for first NHS appointments. Those are not just statistics, as my hon. Friend the Member for North Warwickshire and Bedworth said, but people spending years of life in uncertainty and distress—years when people put their lives and careers on hold, delaying their education and questioning whether they will even survive long enough to be seen. Where care is delayed, it is denied, and 48,000 trans people are currently on waiting lists. Many are pushed towards unregulated overseas routes, not because they want to bypass safeguards but because the alternative feels unbearable. Families make decisions out of love and desperation, often fearing self-harm or suicide if they are left without support. That is not a failure of those families; it is a failure of an outdated system, which apparently is unfortunately questioning its duty to these individuals.
Josh Newbury (Cannock Chase) (Lab)
Something that I hear from concerned parents of trans children and young people, who are often such powerful advocates for them, is that they feel powerless to help their children, so does my hon. Friend agree that support and guidance for families and friends must absolutely be embedded in gender-affirming care, as we hopefully expand and invest in that?
Oliver Ryan
I thank my hon. Friend for that very relevant point. He took the words right out of my mouth, to quote Meat Loaf. We must also recognise that the wider picture, though, is that transgender people face questioning or even denial of their very existence as people. They face barriers not just in specialist gender and transitioning services, but across society as well as our healthcare system, including GP surgeries, maternity care, cancer screenings and mental health support. Too many avoid seeking help altogether not because they are disengaged, but because they fear being misunderstood, judged and discriminated against, or turned away, as unfortunately they are, as the evidence tells us.
Taking this away from silly social media debates, evidence-led medicine, properly funded services and clear clinical guidance do not harm patients; they protect patients. In a world where there is still so much hostility, we have a responsibility and a duty to work harder to ensure that everyone has a place. I know that this Labour Government, at their core, believe that. This House has a responsibility to speak up for those individuals who are too often drowned out by fear and misinformation and by the madness of the online space because we owe it to the sort of country we want to be, where we consider everyone in a mature, dignified and rational way to be worthy of healthcare.
I am not transgender, but I believe in fairness and the principle of good, timely, effective, universal access to healthcare, which applies to transgender people as much as anyone else, because at its core, this is about whether we meet people at their most vulnerable moments with care or with closed doors, and I know which side of that choice I stand on. I hope to hear the Minister take up the points my hon. Friend has made, and I hope to see a more dignified approach to this debate from all concerned in future.
Danny Beales (Uxbridge and South Ruislip) (Lab)
It is an honour to serve under your chairmanship, Mr Turner, and I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for bringing us this debate. I am proud to call her a colleague and a friend. She is an exemplary part of the LGBT movement, and I am proud to associate myself with her and her comments in this debate.
We have heard already about the extraordinary length of waiting lists for gender-affirming care. Based on current appointment rates, a trans person can expect to wait an average of 25 years across the UK for an initial appointment to start gender-affirming care. That is simply not good enough, and we would never accept this in any other patient category in our NHS. We have heard much in this debate about the delays in receiving this care and the devastating impact that has on the lives of transgender people. With that in mind, I would like to ask the Minister whether waiting times for transgender patients are included within the current target to cut waiting times to 18 weeks by the end of this Parliament. Can she commit specifically to decreasing the length of waiting times for gender care by the end of the Parliament?
The second issue that I want to raise—which we have heard about already—is the operation of NHS gender care services more generally, and shared care as an important component of them. Once a gender clinic deems a trans person’s medical transition complete, it discharges them from its care to that of the GP, who will then authorise hormone prescriptions and contact the clinic about any issues. However, GPs in my constituency —and many that we have heard about in this debate—are increasingly refusing to enter into shared care agreements. The rate of such rejections has gone up from 5% to 21% in the last 12 months. Will the Minister therefore commit to clarifying the roles and responsibilities of different NHS services for the provision of gender-related healthcare? It is unacceptable that those who have waited years or decades for initial appointments, who have jumped through all the hoops possible to get NHS gender care, and who are finally in receipt of NHS prescriptions from NHS doctors, are then in practice unable to receive a prescription because their GP has unilaterally decided not to perform blood monitoring tests and provide that shared care support.
It is vital, as has been said, that we ensure access to a range of health services beyond gender-specific needs, whether sexual health services, reproductive health services, or primary and secondary care more generally. The voluntary and community sector, including trans-specific groups, perform a vital role in providing services, brokerage, networking and support in the health service but they are often poorly funded. I encourage the Minister to see what the NHS can do to support trans-led health organisations within it.
Unfortunately and increasingly, a hostile environment is being developed across much of the media. It seeks to erase the existence of trans people from our past, present and future. It is vital that we speak up about their existence, and about the experience of our constituents. I have been contacted by many of my constituents who are trans to detail the impact that the media, political and public discourse is having on their lives. I welcome this debate as part of resetting that discourse in this place and in our society. Fundamentally, this is about treating all people with dignity and respect, and about recognising that trans people exist, as do their health needs.
Karl Turner (in the Chair)
We have four minutes remaining for three speakers.
John Slinger (Rugby) (Lab)
It is a pleasure to serve under your chairship, Mr Turner. I feel it is incumbent on me to speak out on behalf of parents of trans people and, by extension, their children. On a couple of occasions, such parents have come to see me with, frankly, some of the most harrowing cases I have heard as an MP. One family is planning to leave the country. What kind of country have we become where that is even a possibility? One parent’s child, who is currently receiving puberty-blocking drugs and who has been thriving at school and socially as a girl, has in recent months seen her horizons shrinking just at the moment she hoped they would be expanding, as is the right of any young person. As people opine about rights, and debate the apparent clash of rights on this sensitive topic, hon. Members and members of the public would do well to put themselves in the shoes of that girl. How is that young person to feel, knowing that there is a growing hostility towards people like her that is being weaponised, exploited and unleashed?
Although of course it is right that there is rigorous scrutiny of the efficacy of drugs, given the perceived risk of harm, I ask the Minister to consider that thousands of young people are deeply fearful because they are currently on puberty blockers that are now being banned. Just imagine if we suggested taking drugs away that treated a conventional medical issue. That would cause enough fear, but imagine what it must be like to fear that your very essence as a human being is going to be damaged against your will. As others have mentioned, the trial of such drugs will be for 226 young people, but many thousands are waiting to be seen by gender identity services, some of whom are ineligible for the trial anyway. We must put the humanity back into the debate about human rights, especially when they are seen to clash. We must put humanity back into our deliberations and the human back at the centre of our thoughts. Empathy and kindness cannot be drowned out in a debate about rights, and I will continue to speak up for vulnerable people.
Rebecca Smith (South West Devon) (Con)
It is a pleasure to serve under your chairmanship, Mr Turner. I will be brief because we are running out of time. Detransitioners are an often marginalised and misunderstood group. Ritchie Herron is a civil servant who underwent gender surgery in 2018 in order to live as a woman. That involved rearranging tissue in the genital area to create a vaginal opening. When he decided to detransition, he was concerned that specialists were unable to advise him clearly about the correct dosages of hormones that he should take during the process to avoid increasing his risk of osteoporosis. In brief, I simply ask the Minister what her Department is doing to look at how the NHS supports those who are detransitioning? That is not to say that those who are transitioning should not be able to access the support that they need, but what is the NHS doing to support those who want to detransition, especially those who experienced puberty blockers at a young age?
David Burton-Sampson (Southend West and Leigh) (Lab)
I congratulate my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) on introducing the debate. I will be brief.
A trans woman from my constituency told me:
“Transgender healthcare. Even these words feel contentious… If I have a toothache, I understand that I can book an appointment to see a dentist. The pain I was feeling radiated through every aspect of my day, but for a long time it seemed impossible to name. Even when I finally found a way to begin to understand this pain, I was met with a second, greater barrier. Reaching out to the dentist doesn't make me feel ashamed and like a monster.”
That is just one small snippet of many stories I have, and I could share many more today. Trans people are human beings, and we need to start treating them as such. I await the outcome of the Levy review, but live in hope that it will focus on the safety, dignity and autonomy of trans and non-binary people. Time will tell.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve under your chairmanship, Mr Turner. I thank the hon. Member for North Warwickshire and Bedworth (Rachel Taylor) for securing this important debate on healthcare for transgender people and the excellent opening speech she made.
As Liberal Democrats, we believe that everyone should have the freedom to live their lives as who they are, with their fundamental rights protected. Nobody’s health or life chances should be limited or determined because of their sexual orientation or gender identity.
Liberal Democrats strongly support better specialist healthcare services for people who are struggling with their gender identity. These individuals are often the most vulnerable and marginalised in our society, and it is key that they get the support they need from both the Government and healthcare services to ensure they are protected.
I will start with young people. The old system—a single clinic with a shockingly long waiting list, rated “inadequate” by the Care Quality Commission—was clearly failing vulnerable people at a very difficult point in their lives. Before the gender identity development scheme closed, more than 5,000 young people were stuck on that list. They were left waiting for a first appointment for almost three years on average.
For teenagers going through what are often incredibly difficult experiences, three years is an eternity. I have met parents in my constituency surgeries who are visibly distressed by the additional pressure and interminable wait for help for their children or teenagers. We must try to do better for these families. Liberal Democrats have consistently campaigned for action to tackle appallingly long wait times across the NHS, whether it is for cancer treatment or mental health, and it is right that we do so for gender identity services, too.
Trans people should not face a delay in receiving healthcare just because they are trans, and the current situation of waiting years is simply unacceptable. That is why change is needed, and why Liberal Democrats have long pressed the Government to establish new specialist services and recruit and retain more specialist clinicians—so that trans people can access the appropriate, individually-focused and high-quality healthcare that they need.
The NHS’s move to create multiple new regional services is therefore welcome, but only three are open now—in London, the north-west and the south-west—leaving those who have already been stuck on waiting lists for years to wait even longer. There is no indication yet of when the other centres will open.
I hope the Government will show far more urgency in getting these centres up and running properly, or more people will be denied the critical care they need as they languish on long waiting lists. I urge the Minister to take this opportunity to put forward a solid timeline on delivery for the future centres.
Moving on to adults, we are concerned that the current waiting list for adults trans people attempting to access gender identity clinics in the UK is on average five years, and there are some reports of much longer averages of 12 years in England or even longer, as the hon. Member for North Warwickshire and Bedworth highlighted. That is unacceptable for people in distress.
Trans adults have significantly higher rates of mental health conditions, such as autism, dementia and learning disabilities, so timely help is really important. Furthermore, many patients report discrimination, misgendering or the refusal of standard services. Surveys reveal that 40% of trans individuals experience negative healthcare interactions and 21% say their needs were ignored. We have heard about the devastating impact that can have on these real people.
I welcome the commissioning of the Levy review into healthcare for trans adults. Will the Minister clarify when we might expect it to conclude and report back? I hope it will cover both the quality of healthcare and its timeliness. We believe that trans people have the right to be seen by a specialist within 18 weeks, as set out in the NHS constitution, and that they deserve further support while on an NHS waiting list, such as mental-health support and gender-affirming care. Therefore, I welcome the fact that the NHS has doubled investment, opened new clinics and initiated wellbeing pilots offering digital mental health and community support while patients wait, but there is still much more to do.
It is critical in our modern and inclusive society that no one should wait longer or suffer inappropriate care just because of their sexual orientation or gender identity. I urge the Minister to ensure that all UK citizens are provided with adequate care, support and protection by increasing the availability and quality of specialist gender services across the country.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate the hon. Member for North Warwickshire and Bedworth (Rachel Taylor) on securing this important debate. I declare an interest: I am an NHS consultant paediatrician and I have cared for those with gender dysphoria in the past, and am likely to do so in the future. As we discuss a fairly heated topic, we need to remember that there are people experiencing significant challenges, and they deserve the very best healthcare based on need and the best evidence.
One challenge is that name and sex records are sometimes different from how people are referred to in a ward. The previous Conservative Government launched the Sullivan review, which found that a failure of NHS bodies to record biological sex meant that some people were not invited to sex-specific screening. It recommended that we should not combine questions on sex and gender, and that putting politics before patients threatens clinical care. When will the Government formally respond to the Sullivan report? When does the Minister expect to implement its important recommendations? How will the Government ensure that intimate care is provided by someone of the same biological sex where possible?
I would also like to raise the issue of phalloplasty, which is a major surgery on healthy bodies, creating a penis. According to the NHS website, it causes urinary incontinence, loss of sexual function, and in 3% of cases, necrosis and loss of the penis. Is the Minister confident that the NHS is doing the right thing with this surgery?
I want to move on to talk about children with trans identity. We have been talking about the puberty blockers trial. Why is that trial occurring? Drugs are, unusually, being given to children with physically healthy bodies. Despite telling Members of this House that he was comfortable with the trial, the Secretary of State said on Friday to the media that he was “uncomfortable”. Why is it being considered before the completion of the data linkage study recommended in the Cass report?
Some 9,000 children went through the Tavistock gender identity and development services. Many regretted irreversible damage to their bodies. Why have the Government chosen to experiment on a new batch of children before the data linkage study recommended by the Cass report is complete? What steps is the Minister taking to secure that data? What steps is she taking to hold to account the people who are obstructing the data linkage study? What assessment has she made of the motivation of those obstructing a study that, at its heart, is designed to protect children?
What of the trial itself? Some 226 children will receive puberty blockers—is that a limit? Will there be no more by law? They will be randomised into treatment now or treatment after 12 months, and analysed after just two years. When someone receives the drug for only a year, they will still be a child. What meaningful results can be obtained over that period?
The true control group of those not receiving the drugs is not randomised, but chosen or matched from a different trial—the Horizon Intensive trial. Is the Minister concerned that that may introduce a bias? The criteria for getting puberty blockers under the trial require that one parent consents, not necessarily both—one might disagree—and the clinician must think it will benefit the child, but on what specific criteria will the clinician make that decision? Is the Minister concerned to ensure that ideology does not affect judgment?
The Cass review said that the majority of children with gender dysphoria will recover from their distress without any medication, and that it is not currently possible to predict which children they would be. Does the Minister accept that the vast majority of children in this, the Streeting trial, are physically healthy children whose distress would get better without puberty blockers, and that this Labour Government are choosing to give potentially dangerous drugs to children, most of whom will not need them?
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairmanship, Mr Turner. I thank and congratulate my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) on securing this important debate. Without giving away any state secrets, we are roughly the same age; I am not gay, but I also marched and campaigned against section 28—I remember those days from very early on.
I want to say from the outset that this Government stand for the important principle in our healthcare system—which has been echoed this afternoon by many Members—that everyone in our country deserves access to first-class healthcare. I will not rehearse here the mess that we inherited from the last Government; we do not have time. However, we are determined to ensure that what I have set out happens. If we are to make good on that principle, we must take account of the diverse needs of our society. That of course includes trans people and the wider lesbian, gay and bisexual community.
Colleagues are right to say that transgender people experience significant and specific health inequalities throughout their lives. As we have been reminded again this afternoon and should always bear in mind when we have debates in this place, these are real people’s lives. Many people are with us today in the Public Gallery, and I am sure that many others are watching online. That is why this Government have commissioned NHS England to undertake a health evidence review, led by Dr Michael Brady, the national adviser on LGBT health, whom I met in advance of this debate. He has held the position of adviser since 2019 and works as a sexual health and HIV consultant at King’s College hospital. I am pleased that he is doing that review. The work is considering how we can better understand lesbian, gay, bisexual and transgender healthcare needs and will provide a clearer picture of what the problems are—the data, the evidence—and how we need to address them.
That is particularly important in relation to preventive healthcare and the inequalities space. The Government have been very clear about our commitment to reversing the shocking health inequalities in this country. My hon. Friend the Member for Walthamstow (Ms Creasy) highlighted where there is good practice across the country. In addition, it is important to highlight the fact that despite the umbrella term of LGBT, needs are different in this group, and equality terms are covered by different aspects of the Equality Act 2010. All of this needs to be clearly evidenced and brought forward in the work to which I am referring. Lots of people asked this question: we anticipate that the findings of the evidence review will be finalised in the new year. We will then be considering those very carefully.
We have talked this afternoon about the fact that trans people—they are the subject of this debate—have unique health needs and specialist services to support them. This Government are improving specialist gender services for children, young people and adults in England. I recognise that those wishing to access gender services are waiting far too long for a first appointment. We are determined to change that, which is why NHS England has increased the number of adult gender dysphoria clinics in England from seven to 12, with the roll-out of five new pilot clinics since July 2020. These clinics are helping to tackle long waits, but we know that waiting times for these services can be distressing and are having a real impact on people’s wellbeing. To support those facing long waits, the Department of Health and Social Care has tendered for a new Waiting Well pilot. That will run for 12 months and provide those on the waiting list for the gender dysphoria clinic in the south-west region with access to support and information before appointments. The aim is for the pilot to launch in early 2026 and to inform plans for a national offer, subject to effective evaluation.
It is vital that transgender people are able to access the high-quality healthcare that they deserve. As we have heard, NHS England has asked Dr David Levy to carry out a review of adult gender services, because that was a specific recommendation from the Cass review of children and young people’s gender services. As an independent chair, Dr Levy will examine the model of care and operating procedures of each service, and is carefully considering feedback and outcomes from clinicians and patients. To respond to a number of questions this afternoon, that includes issues relating to shared care prescribing and monitoring of hormone medication. Dr Levy has been supported in his review by independent senior clinicians and professional bodies. I expect the review to be published shortly, and I know that my right hon. Friend the Secretary of State will inform the House as soon as that has happened, but let me assure Members here, and people listening to or reading about this debate, that we will use the review as a basis to improve NHS adult gender services.
Issues relating to children have been raised this afternoon. I know that children and young people’s gender services are a sensitive topic that elicits strong opinions, some of which we have heard today. Let me be very clear: we will take an evidence-based approach when it comes to the health and wellbeing of all children and young people. Their safety is our primary concern. We are committed to implementing the recommendations of the Cass review, to ensure that children who access these services receive the same high-quality care as any other child or young person accessing NHS services. We believe that the Cass review remains an excellent, evidence-based report. I urge all hon. Members to use it as their guide when making assertions, including in their understanding of gender dysphoria. We welcome that report and accept its work; it is our guidance for navigating healthcare for transgender young people.
It is still my understanding that the report is not supported by the Green party, and not properly supported by the Liberal Democrats, so when we talk about evidence, colleagues perhaps need to check and go back to the source report, because we are determined to follow the evidence and great work done by Hilary Cass.
NHS England has opened three new services in the north-west, London and the south-west, as we have heard. Those services operate under a fundamentally different and new clinical model, in which children and young people get the tailored and holistic care they need from multidisciplinary teams of experts in paediatrics, neurodiversity and mental health. A fourth service in the east of England is expected to open early in the new year. NHS England aims to open service provision in every region of England by 2026–27. That will help to further reduce waiting times and bring these services much closer to the homes of the children and young people who need them.
On puberty blockers and the pathways trial, the Cass review was clear that better quality evidence is critical to understanding the effects of puberty-suppressing hormones. That is why the NHS has removed them from children’s gender services, and why the Government have indefinitely banned them in private supply.
Dr Cass also recommended a clinical trial to understand the effects of these hormones, which is why the pathways trial has been established. In this controlled study, puberty suppression will be offered solely within the context of the comprehensive assessment and psychosocial support now offered by the NHS. The trial has undergone comprehensive review, has received independent scientific, ethical and regulatory approvals, and will soon open to recruitment.
I know that many hon. Members have strongly held views about this research. However, I want to be really clear that safeguarding the children and young people participating in this trial is our absolute priority. In response to the hon. Member for South West Devon (Rebecca Smith) on detransitioning, I will add that NHS England has called for evidence from people with lived experience and from professionals; I understand that the consultation closes on 28 December.
Karin Smyth
I will finish.
I met Dr Sullivan recently to understand her report and how it impacts on the Department of Health and NHS England. My understanding is that each Department is looking at the recommendations of her review, and that it is important to have accurate data. I will ensure that the hon. Member for Sleaford and North Hykeham (Dr Johnson) gets an answer on whether there will be a formal Government response.
This Government were elected on a manifesto to bring down inequality. We are doing so through a number of different measures—on the soft drinks industry, free school meals, the generational ban on smoking and Awaab’s law. In her Budget, the Chancellor lifted half a million children out of poverty at the stroke of a pen.
We are determined to ensure that no one falls through the cracks of our health system, and we will give transgender people the care they deserve. I hope the actions I have set out today demonstrate our commitment to that goal and our focus on improving healthcare provision for transgender people, across all ages, based on good clinical scientific evidence. We will cut waiting lists for gender services, along with all other waiting lists, and ensure that healthcare is always evidence-based, improving health outcomes for trans people and the wider community.
Rachel Taylor
I thank everyone who has spoken in this debate, and all my hon. Friends, for their passion, care, advocacy, understanding, kind words and leadership in this area. The tone of the debate has proved that we can, away from the glare of culture wars, have a sensitive and nuanced discussion about how to guarantee care for some of our most vulnerable citizens and how to support their families.
I thank the Liberal Democrat spokesperson, the hon. Member for Mid Dorset and North Poole (Vikki Slade), for her understanding and clarity of thought; she is a strong advocate. I also thank the spokesperson for the Green party, the hon. Member for Bristol Central (Carla Denyer).
I thank the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), for coming here divested of some of the toxic and inflammatory zeal, even though she seemed more concerned about the small number of people who are detransitioning rather than about all trans people and their healthcare.
Most of all, I thank the Minister for her remarks. I welcome her commitment to first-class healthcare for everyone. I welcome the Brady review reporting early in the new year, including the fact that there will be between seven and 12 healthcare centres for young trans people, with more clinics to come around the corner. I also very much welcome her Waiting Well pilot and hope that it can be rolled out across the country.
I want to finish by broadening out this discussion. This has not been an easy year for trans people. The Supreme Court judgment and the misguided, unnecessary interim guidance that followed from the Equality and Human Rights Commission have created genuine fear that rights long enjoyed are now at risk. We have heard today about the poor state of healthcare for trans people in this country, and flawed guidance risks making that situation worse.
I have heard from trans and non-binary people who have developed urinary tract infections because they feared going to the toilet. There is no doubt that the toxic culture wars have the potential—