Transgender People: Provision of Healthcare

Karin Smyth Excerpts

Tuesday 16th December 2025 Westminster Hall

[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.

[Nadia Whittome]

Will the Minister give way?

[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.