“For Women Scotland” Court Ruling: First Anniversary
Debate between Iqbal Mohamed and Caroline Johnson(5 days, 7 hours ago)
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Iqbal Mohamed
I am not a medical doctor—there are experts in this room—but if somebody has gone through operations under the NHS and that is medically assessed and professionally delivered, I respect their current biological status. If I have used the wrong language, I apologise, but these are special cases. The case that the hon. Member mentioned earlier in an intervention, where somebody had had breast cancer and had a double mastectomy, and may be misidentified as male, is a special case; that person has gone through a physical change that may make others see something different from who they are. Those are separate arguments to biological males identifying as women.
As I was saying, none of these transgender constituents of mine has come to me and said, “I want to be entering single-sex spaces of the other gender to make me feel that I am who I believe that I am.” I think that needs to be understood—that this view is not universal across the transgender community.
Clarity in the law is profoundly important. Without it, public bodies, service providers and indeed individuals are left navigating uncertainty. Inconsistent interpretations risk undermining both compliance with and confidence in our legal system, to distressing effect. Rights that already exist in law for any gender, biological sex, man or woman, cannot be usurped by new demands from people in our community, whether it is trans, or Muslims, or Christians, or people of no faith. Rights, once they are acquired and in law, should be protected and implemented, and any new demands or changes required to support in full other members of the community who may differ must be grappled with and dealt with by the Government without undermining existing rights.
The Court’s judgment provides a clear, coherent framework within which decisions can be made, particularly in relation to single-sex services, which the Equality Act explicitly permits. Yet this judgment did not remove rights from trans people. Protections preventing discrimination remain firmly in place, as they should. Trans rights are human rights where they are not impinging on somebody else’s human rights. That is a really clear distinction that we need to make.
This is not a zero-sum question of one group’s rights being set against another’s, with gains for one group coming only at the expense, or at the loss, of the rights of another. Rather, it is about ensuring that the law is applied as intended, recognising distinct protected characteristics and giving effect to each in a way that is workable and, crucially, fair. Of course, implementation must be done sensitively and responsibly, taking pains to ensure that the human rights and dignity of all are respected. The law already allows for flexibility to accommodate this.
It is therefore really difficult to understand why the public sector, especially the NHS, is spending hundreds of thousands—if not millions—of pounds on going to tribunals, knowing that it will lose, for an ideological, entrenched reason. That should not be happening. That money should be spent treating women, trans women, trans men and other patients within the NHS. I pay tribute to the Darlington nurses and Jennifer Melle for being here, and for being the light, or the source of information, around this topic, having gone through so much suffering and persecution to stand up for their basic human rights as biological females.
Dr Caroline Johnson
The hon. Member is talking about the way care is managed within the NHS. Has he thought about the importance of ensuring that the biological sex of trans women and trans men is known by the clinician who is treating them? If they are on a ward, there will be a presumption that they are the same sex as the other people on the ward, which could leave them in a difficult position medically. If they receive a blood test result, perhaps for haemoglobin, the results will be interpreted based on the sex that the clinician understands the person to be, which could lead to an error if that is not the patient’s actual sex. When a patient is invited for screening, they need to be invited for the right type of screening and not the wrong type of screening, for their own safety. When statistics are produced that help with epidemiology and further healthcare, they also need to be done in an accurate way.
Iqbal Mohamed
I thank the hon. Member for her expertise in this area. Recognising biological sex is in the interests of trans people as well. We are not just different on the outside; we are different on the inside. Hospitals need to be able to treat people for who they are, not who they believe they are or who they want to be. We could end up with mistreatment, misdiagnoses and further litigation against the NHS for causing harm to somebody because we did not explicitly take into account their biological sex.
The law already allows flexibility to accommodate the implementation of human rights for all. It permits the provision of single-sex services where justified, while also enabling appropriate alternative arrangements, such as unisex facilities, where these are needed to ensure that everyone is treated with respect. However, the clarity in principle that the ruling provides must now be matched by clarity in practice.
We are now seeing movement from organisations. The International Olympic Committee recently announced that it will not allow non-biological women to compete in women’s sport. Girlguiding has now updated its guidance to go back to admitting guides based on biological sex. That is not discrimination against trans people; it is just common sense, and the protection and implementation of existing rights for girls and women.
In that spirit, I ask the Minister three specific questions. First, what steps are the Government taking to ensure that public bodies and service providers are not delaying implementation of the judgment under the mistaken belief that they must wait for further guidance before acting? The Supreme Court ruling was black and white, and gave all employers, the public sector and sporting bodies enough information to proceed with implementing it.
Secondly, how do the Government intend to support service providers in striking the balance between single-sex and unisex services in practice, particularly in frontline settings such as healthcare, education and local authority services, where the consequences of uncertainty are often felt most acutely? Finally, can the Minister set out how the Government intend to communicate clearly with the public about what the judgment means in practice, so that both women and trans people understand their rights and protections under the law?
As legislators, we have a special responsibility to ensure that the law remains coherent and relevant to the world we live in. One year on, I hope that the message is clear. The law has been clarified. The rights of women to access single-sex services are justified and recognised. The protections afforded to trans people remain in place, and the responsibility now lies with all of us—whether that be the Government, public bodies, parliamentarians, employers, sporting bodies or any other group—to ensure that this clarity is translated into consistent, lawful practice.
Puberty Blockers Clinical Trial
Debate between Iqbal Mohamed and Caroline Johnson(3 weeks, 6 days ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship this afternoon, Mr Mundell. I must first declare an interest as an NHS consultant paediatrician. I thank James Esses for the petition and the thousands of people who have signed it, including many of my constituents, for enabling today’s important debate. I also thank the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for leading the debate so well.
The petition asks the Government to cancel the puberty blockers trial and to safeguard vulnerable children. Perhaps it is worth considering whether clinical trials in children are a good idea in principle. The answer, of course, is yes. Children are not just small adults; they have different illnesses from adults, they present with different symptoms and respond differently to medication, and they require different doses at different ages. Properly designed clinical trials ensure that children’s medicines are safe and effective for them.
However, today we are discussing one particular trial: a proposal to give puberty blockers—gonadotrophin-releasing hormone analogues—to children, specifically for gender incongruence. Perhaps at this point it is worth considering why doctors and others prescribe medication; we do it to treat or cure disease, to treat or lessen symptoms and to aid in diagnosis.
What does this trial seek to do? On the face of it, it seeks to establish whether puberty blockers are a safe and effective treatment for gender incongruence. ICD-11 defines gender incongruence as:
“A marked and persistent incongruence between an individual’s experienced gender and the assigned sex”.
To suggest persistent incongruence with gender stereotypes is wrong could undo years or decades of rolling back gender norms. If it is not causing the person any distress, why would we want to treat it, especially when we know that most children, even those with gender dysphoria who do have distress, will get better without any puberty blockers?
Currently, there is no way to identify which children will persist with a trans identity as adults and which will not. The much-delayed data linkage study could help with that. It could enable more targeted interventions and may also provide information on the long-term outcomes for people who have taken puberty blockers in the past. However, the Government insist on pushing on with the puberty blockers trial anyway, before the data linkage study is complete. Why? In written parliamentary questions, Ministers have said that they expect the data linkage study to be finished by April 2027, so what is the rush?
What is the point of the treatment? It has been suggested that it helps transgender adults pass more easily as the opposite sex and potentially avoids surgical operations in adulthood, but how on earth can it be ethically, morally or medically right to treat a large group of children with risky medication to give cosmetic benefits to a much smaller number of adults?
There are also cosmetic risks to the treatment. The penis grows very little between the ages of three and 10 years. The use of puberty blockers restricts growth, meaning those with a persistent trans identity may struggle with having enough tissue for a vaginoplasty surgery, and those who do not have a persistent trans identity may struggle with normal intimate relationships.
As mentioned earlier, the Secretary of State has said that he has confidence in this trial. Now it has been paused, we can presume that he is not quite so sure. But can we, patients and the general public have confidence in this trial? There are certainly causes for concern. In fact, there are so many that I cannot speak of them all today, but I would like to speak of a few in the time I have available.
First, on the selection of patients, we have had a dramatic change in the demographic. There has always been a small number of children uncomfortable in their own bodies, but there has been a rapid increase, which is not fully understood, particularly among girls. Many of them are in care, some have autism spectrum disorders and many are same-sex attracted. We need to understand this before prescribing irreversible treatments.
We do prescribe—and I have prescribed—drugs that are high risk or potentially harmful to children. An easy example would be chemotherapy, but that is being given to save a child’s life; it is not used to pause a perfectly normal physiological process in a physically healthy child. The risks of these treatments have been listed today, but I will list just a few: fertility problems; idiopathic intracranial hypertension; demineralisation of bone density, leading to fractures; in some studies, an increase in depression and anxiety; and the long-term loss of sexual function in some patients. We have discussed consent. How do you get consent from a parent of a child—a boy or a girl at Tanner stage 2—about long-term sexual function and fertility?
On the design of the trial, it is said to be a randomised controlled trial. Well, it is, but that is a bit of a fudge, because instead of an actual randomised controlled trial where some patients receive puberty blockers and some do not, it has given some now and some slightly later, with a very short difference in the timing. The comparison group that does not have any puberty blockers at all is taken from a slightly different population, which introduces an unnecessary bias. The trial’s organisers have said that they are doing that because they think the children would get the drugs from elsewhere or from abroad, but that is not how we do medical trials. When I have raised this issue, Ministers have responded that it cannot be blinded, but blinding and randomisation are not the same thing. The trial is also far too short to provide data on long-term outcomes.
On the process of the trial, the hon. Member for Gower (Tonia Antoniazzi) raised questions about what children are being asked as part of this trial. Why is the trial proposing to ask children about their sexual experiences? Why is this helpful to the trial?
Dr Johnson
I will not because I am aware of the time.
The Commission on Human Medicines’ report heard that, because trials of puberty blockers have been blocked, some clinicians are trying to use other drugs to limit puberty, such as spironolactone and cyproterone acetate. There have been reports that the number of prescriptions for spironolactone in 10 to 17-year-olds is going up. Could the Minister confirm whether that is the case and what the Government are doing to look into it?
The MHRA was happy with the process; now it is not. What has changed? None of the issues raised seem to have not been raised before. The Government are being secretive about it: in February, Ministers brought forward a written statement referencing an MHRA letter in November, but the Minister is refusing to publish it. I have asked Ministers whether they talked to MHRA officials about the trial before February 2026, and they will not answer the question. There was a letter between the MHRA and KCL; I asked when it was received, when the Department became aware of it and when Ministers became aware of its contents. They will not tell me.
What about the people controlling the trial? As has also been mentioned during this debate, Professor Jacob George has been recused from further involvement. According to the MHRA’s statement, this is “a precaution”, because of social media posts made before his involvement. Why have those who have made the opposite type of comment not been recused too? This will inevitably make members of the public think there is bias involved.
There is an oversight board. What has the Minister done to ensure that the clinicians and scientists on that board are impartial, and that it is balanced between both perspectives? The Tavistock trial was supposed to report to the MHRA, but it did not, seemingly with no consequence. There will be lay members on the board with lived experience; will one of those be a detransitioner, or will they all be people on one side? That would increase the perception of bias in this trial.
In summary, this is a trial of risky medication on healthy children, most of whose features of gender incongruence will resolve in time, given normal puberty. What is particularly worrying is that, at the end of this treatment, the trial has so many flaws that it is bound to be disputed, whatever the result.
To give this treatment, the lead clinician will need to think that there is a reasonable prospect of a patient benefiting from puberty blockers. Given all that has been said, how can any clinician believe that that is the case? I hope we can all agree that we do not need a clinical trial to know that helping a child to be at peace with themselves and their body is infinitely preferable to a lifetime of harmful medical intervention.