Gender Incongruence: Puberty Suppressing Hormones

Debate between Karin Smyth and John Hayes

Wednesday 30th April 2025 Westminster Hall

[Karin Smyth]

I thank my hon. Friend for that intervention; I hope to get on to that subject in my speech. It is important that people are aware of that progress.

I know that many people are concerned about the ethics of this research, as the hon. Member for Reigate and the right hon. Member for South Holland and The Deepings (Sir John Hayes) both noted. I assure hon. Members that the UK has, as we know, extremely rigorous and robust ethical approval pathways, and that no clinical trial can proceed without the necessary independent scientific approvals.

We already regularly use those processes to consider clinical trials in children so that we can evaluate new treatments for a whole range of conditions, including cancer, depression, respiratory infections, or any illness. Many aspects of the methodology of this trial are still being looked at, such as how long it will follow children, how many children will be on the trial and how the demographics of the trial will be constructed. That is all still to be confirmed and approved; many hon. Members asked about those points today. All participants in the trial will also be part of the ongoing observational study.

Following the decision by the Secretary of State for Health and Social Care about puberty blockers, which was based on the evidence, we needed to make sure that we got on with helping scientists, researchers and clinicians to do their jobs. Some people have called for the Government to stop those experts from pursuing this line of inquiry, and we have heard such calls again in this debate. They have argued that the decision to halt the sale and supply of puberty blockers should be the end of the matter, and that young people should not have access to this medication, come what may. That would be to ignore the distress and real experiences of young people, and the Government have no doubt that it would drive people towards possible illegal and underground routes, shutting off young people’s access to conversations with professionals and the opportunity to pause and consider other options.

Instead, as Dr Cass suggests, we can set out a proper path to treatment that involves young people, their parents, clinicians and mental health professionals. Knowing that they are on a path will reassure young people that they are being taken seriously. The cautious process that they will have to work through before joining a trial means that young people will have access to support and counselling, which may result in them deciding against joining the trial and pursuing a medical route. That is an approach entirely missing over recent years.

We all agree that treatment should be offered based on the best available evidence, and clinical trials in the UK are considered to be the gold standard for evaluating healthcare interventions. The Cass review found:

“The evidence base underpinning medical and non-medical interventions in this clinical area must be improved.”

That is why we have commissioned the PATHWAYS programme of research, one aspect of which includes the world’s first clinical trial designed to help us to better understand the relative benefits and potential wider effects of the use of puberty blockers in affected children.

We must look at the most appropriate medical and non-medical approaches to support physical, emotional and psychosocial health. That is why the trial forms just one component of a wider study and a growing portfolio of research, jointly hosted by NHS England. That includes looking at the experiences of the 9,000 adults who, as children, were cared for under a previous model of NHS care, which I know the hon. Member for Reigate has described as a “medical scandal”. Dr Cass was clear in her review that both a clinical trial on puberty blockers and a data linkage study, which many hon. Members have raised today, are important to improving the evidence base on gender incongruence in children and young people.

Regardless of individuals’ views on the practices of the Tavistock, I hope we can all agree that learning from the experiences of those thousands of people who have accessed puberty blockers is important; it will provide different and separately valuable information from the clinical trial. That data alone, however, will not provide the answer as to whether we should—or should not—consider routinely prescribing these drugs in the future, or continue the ban indefinitely.

The adult gender services have now committed to sharing their data, a point also raised by hon. Members. I acknowledge that we need to move quickly, and I expect to be making progress on this soon. We will consider all data that is relevant to puberty blockers, including from the adult gender clinics.

As with all clinical research, the team leading the trial must ensure that approval is obtained from the regulatory authorities, including one of the Health Research Authority’s independent ethics committees and the Medicines and Healthcare products Regulatory Agency. Those are all standard steps where the research receives full scrutiny. Once approvals are granted, the study protocol will be finalised and published, and only then can the trial commence. I am not able to comment on the finer details of that today, but we will issue further updates when they are available, and I commit to keeping Members updated.

I assure hon. Members that entry into the trial will be guided by strict eligibility criteria. It will involve only young people under the care of the NHS children’s gender services who have received a full assessment, where other appropriate forms of support have been offered and where their clinician supports a referral to the trial. Under the law, if a child is under 16, a parent will have to consent to their participation, and the child also needs to agree.

I am repeating myself slightly, but that level of caution was entirely missing over recent years. This is a more considered and evidence-based approach. In the past, puberty blockers were presented as the magic pill that young people needed to access; this trial will give children and young people the support they need to make these major decisions.

As we have heard today, we are currently in a situation where some people think it is unethical not to provide these treatments, and some think it is unethical to provide them. The reality is that we do not have definitive evidence. When that happens, we routinely ask for the study to be checked by an independent ethics committee. We spell out the uncertainty to young people and their parents, so that they can balance any such risk against their desire to join the trial before deciding whether they wish to participate.

[Sir John Hayes]

Will the Minister give way?

[Karin Smyth]

I am sorry, but I am tight on time.

Uncertainty is common to many new treatments, but through that process, we ensure that those treatments are no longer used in the absence of such evidence. During the trial, an independent committee checks whether new results have emerged from other countries around the world—a question that was raised several times—and, if those results provide evidence that the benefits or risks are clear, such that we could issue clinical guidelines based on them, the trial would be stopped.

We need better-quality evidence to support the NHS in providing reliable and transparent information and advice to children and young people, and their parents and carers, in making important treatment decisions. That is exactly what NHS England and the National Institute for Health and Care Research programme will provide.

I was asked to provide an update on implementing the Cass review, which, beyond that research, we are absolutely committed to doing. From what we heard this afternoon, I am not entirely sure what the Liberal Democrat position is, but we are very clear that we will continue to work on that in lockstep with NHS England. We have opened the three services, and a fourth is planned in the east of England from this spring.

Those services operate under a fundamentally different clinical model, where children and young people get the tailored and holistic care they need from a multidisciplinary team of experts in paediatrics, neurodiversity and mental health. At first, those services saw patients transferred from the now-closed gender identity development service at the Tavistock, but I am pleased that all the services now take patients from the national waiting list. NHS England aims for there to be a service in every region of England by 2026. That will help to reduce the waiting list and bring the services closer to the homes of the children and the young people who need them.

Hospice Funding

Debate between Karin Smyth and John Hayes

Thursday 19th December 2024 Commons Chamber

[Karin Smyth]

My hon. Friend is absolutely right to highlight that need. As I said earlier, end of life care and its stability as part of the wider system, which is a commissioning role for ICBs, was not addressed by the last Government over 14 years. As part of our 10-year plan, that will be important to do.

[Sir John Hayes (South Holland and The Deepings) (Con)]

We can all agree that hospices, such as St Barnabas in Lincolnshire, do vital and valued work. I hope we can also all agree that every Government—Labour and Tory—have increased national health spending, for that is simply a matter of fact. I ask the Minister to show a little wisdom in contrition in acknowledging that the national insurance increase that was imposed on charities and hospices has done immense damage. We welcome the funding today—of course we do—but she needs to be straightforward: was she, or any of the Health team, consulted before the Budget about the impact of the NI increase on hospices, health charities, pharmacies and so on? May I advise her to put down the folder and tell us what she really thinks?

[Karin Smyth]

I have scribbled my own note—the right hon. Gentleman says that he “agrees”— but the issue is that his Government did nothing over 14 years to support or make a change. That is why the announcement we are making is so important. I reiterate my earlier point, which I will repeat every time I am at the Dispatch Box: the Conservatives have not read the Darzi report; if they do not agree with the diagnosis, they cannot agree with the solution. That is their fundamental problem.

Abortion (Northern Ireland) Regulations 2021

Debate between Karin Smyth and John Hayes

Monday 26th April 2021 General Committees

[Sir John Hayes]

My right hon. Friend is right; the Government’s best course of action is to repeal the changes that were made when there was no devolution settlement. There is the prospect of further legal challenge, which I would certainly strongly support given all the things I said earlier about the 1998 Act establishing the devolution settlement; about the fact that this has been described again today by a Committee of this Parliament as being unprecedented; and about the basis on which the Assembly was reassembled and its legal underpinning. What we are doing today is highly questionable and I recommend that the Government think again.

The Minister says that Northern Ireland has some opportunity to interpret the regulations and come forward with its own settlement that stays within the law but does not go as far as some would want. That is true. Northern Ireland can come forward with a settlement, but these regulations are effectively a gun to the head of the people of Northern Ireland, saying, “Either you do what we want by your own decision or we will decide for you.” I hesitate to say anything critical of the Minister because I regard him highly, but it is a slightly deceptive argument to suggest that the Northern Irish can sort this out when a gun is being placed against their heads.

Not for nothing are many people in Northern Ireland very proud of the “One Hundred Thousand” report, confirmed by the Advertising Standards Authority as showing that probably 100,000 people are alive in Northern Ireland today who would not be had the Province embraced the Abortion Act 1967.

Moreover, when talking about the sovereignty of Parliament we must recall that a key aspect is that no Parliament can bind its successors. Section 9 was passed in a Bill the introduction of which defined its purpose in terms of the restoration of the Executive. That was in a previous Parliament and it could have been—it would and should have been—this Government’s course of action to say, “That was then and now is now.” A different Parliament and a different set of arrangements in Northern Ireland necessitates a different approach. That would not have been unreasonable given what I said about the need to maintain the integrity of devolution.

Rather than asking Parliament to pass these regulations, the Government should recognise the current reality and instead ask our new Parliament to welcome the restoration of the Assembly and to repeal section 9, as I said in response to my right hon. Friend the Member for Basingstoke. In making that point, I would say to the advocates of abortion that that would be a debate to have across the House, but more especially in Northern Ireland. If those who want abortion to be more widely available in Northern Ireland make their case and persuade their elected representatives to share that view, living in a democratic kingdom, the majority view will prevail.

It is important to say that the regulations are of course about abortion and its availability in the Province, but they are about something much more: how much we value devolved decision making, how much we respect the different opinions that prevail in different parts of this kingdom and how much we really believe that the sovereignty of this Parliament is enhanced when we are big enough to say that people in different parts of the kingdom can come to different conclusions from the majority view here.

Do we care so little about the distinct regional identities of our Union, unless we take exactly the same approach to abortion in Northern Ireland as in the rest of the United Kingdom, that we would extinguish people’s opinions and eliminate the majority view there? Are we to honour devolution only when those to whom we give power agree with us? Will the Government be content to build their future on past mistakes? Is this an Administration who listen, or do they dictate?

To misunderstand the salience of those questions, or the significance of the answers, would be among the worst political miscalculations of any Conservative Government since the Union began in 1707. As we sit under the gaze of Joseph Chamberlain—

[Karin Smyth]

Will the right hon. Gentleman give way?

[Sir John Hayes]

Before I come to my exciting conclusion, of course I give way.

[Karin Smyth]

The Act of Union 1707 did not apply to Ireland, only to Scotland.

[Sir John Hayes]

That is true, but I did not claim otherwise. I said this would be one of the biggest mistakes since then.

As we sit under the gaze of Joseph Chamberlain, the radical who in the end became allied to the Conservative Government, and who always put conviction above convenience, perhaps today members of the Committee should put principle and conviction first, not convenience, and think again about the regulations. I invite Conservative members of the Committee—and, I hope, members across it—to oppose the regulations because that would send a signal to Government to think again, to listen, to redraw their plans and to behave in a way that maintains our Union, respects devolution and shows that, rather than ploughing ahead regardless, the Government are sensitive to the wishes and interests of the people in every part of the United Kingdom.