Puberty Suppressants Trial

Nusrat Ghani Excerpts

Wednesday 17th December 2025 Commons Chamber

[Wes Streeting]

The shadow Minister asks, “Why?” There is a simple answer. It is because this was recommended by Dr Cass in the Cass review, which was commissioned by my predecessor, Sir Sajid Javid. I think that was the right thing to do, and it is why, when my predecessor brought forward the Cass review, I supported it in opposition. I certainly did not try to play politics with an extremely vulnerable group of children and young people.

I will tell the hon. Lady why. It is because, under the previous Government, those puberty-suppressing hormones were prescribed without proper oversight, supervision or safety, yet we did not hear a peep about that fact for years until Dr Cass, commissioned by Sir Sajid Javid—who deserves enormous credit—did the study, which was published and widely supported and which contained this recommendation. The Conservatives may have changed their tune in opposition, but I remember what they said in government when they published the Cass review and supported its recommendations, so I think their response now is a real shame.

The shadow Minister accuses me of inconsistency, so let me be clear. Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that. Am I uncomfortable about puberty-suppressing hormones for this group of young people for this particular condition? Yes, I am—because of risks. It is why I was also uncomfortable when I upheld the temporary ban by my predecessor and then put in place a permanent ban. The reason I was uncomfortable with that, too, is because I had to look children and young people, and their parents, in the eye when they told me in no uncertain terms that that decision was harmful to them, as have many other clinicians who have opposed that decision.

Whatever my discomfort in this extremely sensitive area, the reason that I have made this decision is that I am following clinical advice and, as Health Secretary, it is my responsibility to follow expert advice. Had the Tavistock clinic faced such challenge and scrutiny a decade ago, we would not be in this mess. The Conservatives were right to commission the Cass review and they were right to accept its recommendations. I accept that there is now a difference on this particular recommendation, but I would urge Members not to walk away from the cross-party consensus we built behind that approach but to build on the work that Dr Cass has done.

Let me turn to the important questions raised by shadow Minister. There will be two groups within the trial, as well as a further control group of children and young people with gender incongruence who do not receive puberty-suppressing hormones. At least 226 participants are required in order to detect a statistically significant difference between the two treatment groups. However, this is not a target and no young person will find themselves on this trial because there is a drive to make sure that a certain number of young people are participating. In order for anyone to participate in this trial, it has to have the most robust clinical oversight from clinicians within the service, as well as national oversight and the consent of parents. It is only where young people will be deemed to benefit that they will be on this programme.

The shadow Minister asks about the data linkage study. That is important. The data linkage study will be undertaken, but when it is completed it will not provide us with the same evidence as this clinical trial. That is why Dr Cass made a distinction between this trial and the data linkage study.

The hon. Lady also asks about the motivations of those who withheld data. That is an extremely important question. It is utterly appalling that anyone in a position of responsibility in the NHS withheld data on a very vulnerable group of children and young people. I accept that there were many well-meaning people involved in these services at the Tavistock clinic, but the fact that Dr Cass found such a lack of rigour, such a lack of standards and such a lack of proper oversight is disgraceful. It is the clinicians who are well meaning and ideologically driven who have given me the most cause for concern in this whole debacle and who have done more harm to children, young people and the trans community than most other people who have taken part in this debate.

I appreciate the work that Dr Cass has done, and I am glad that she is in the other place, bringing welcome scrutiny. Were she not supportive of this approach, I might think again, but she has made her recommendation and given her support. I am following clinical advice. It is not comfortable, but I do believe it is the right thing to do, on balance.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Health and Social Care Committee member Danny Beales.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

The hon. Member for Sleaford and North Hykeham (Dr Johnson) asks, “Why?” Well, it is because trans people exist and their health needs exist. As the Secretary of State has clearly outlined, an independent review made a series of recommendations. There were clearly failures of healthcare, and a further recommendation was that a clinical trial should address this issue. I believe that the Conservatives supported the Cass review, but when it comes to implementing this part of it, they suddenly have collective amnesia about what Dr Cass recommended. Does the Secretary State agree that, in the absence of a trial, there will still be access to these drugs? We know that young people are seeking out private provision. They are seeking unregulated providers of these drugs, so is not a clinical trial both appropriate and the best and safest way of managing any potential risks?

[Wes Streeting]

The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson; you have one minute.

[Helen Morgan (North Shropshire) (LD)]

I hope that everyone in this House can agree that medical treatment should always follow the evidence on safety and effectiveness. It is right that expert clinicians are building this evidence base and therefore right that the Government are seeking to run this trial, because it should be led by evidence and not by ideology.

Given that the numbers on the trial will be very small and the waiting list for talking therapies, which are so important for children and their parents, is very long, with hundreds of thousands waiting, can the Secretary of State explain how he will increase access to NHS talking therapies so people can get the help they need and deserve? In a field with so little research, will he confirm if the pathways trial will look at international best practice in order to take learnings from abroad?

--- Later in debate ---

[Wes Streeting]

Let me reassure my hon. Friend and the House that I am absolutely open to receiving representations and evidence from clinicians involved in the care of children and young people, with insight, expertise and data, including those who might be critical of the approach that the trial team is setting out or, indeed, critical that the Cass review included this recommendation. That is important because the many things that have gone horribly wrong in this area have included the silencing of whistleblowers and the silencing of rigorous debate and discussion.

We have to have this debate with due care and sensitivity for young people in this vulnerable group in particular and for the wider trans community, who feel extremely vulnerable in this country at the moment, including as a result of decisions I have taken as the Health and Social Care Secretary. We have to consider all of that in the round, but we must make sure that at all times we are following the evidence, that we are open to scrutiny and challenge, and that where we are making these finely balanced judgments, we are doing so with rigorous debate, testing the arguments, the evidence and the data. That is why I welcome the urgent question and this discussion.

[Madam Deputy Speaker]

I call Health and Social Care Committee member Joe Robertson.

--- Later in debate ---

[Wes Streeting]

I certainly do not need to be told what my responsibilities are on this. I always take responsibility for the decisions I take. I acknowledge the extent to which the hon. Gentleman and members of his party seek to weaponise this issue, and to personalise it. [Interruption.] We can simply refer back to his question and to the shadow Minister’s reference to the “Streeting trial”—if that is not personalising, I do not know what is.

I’ll tell you what: I will take an evidence-based approach. I have done that on this issue from day one. Had the Conservatives done so, we would never have seen the Tavistock scandal. We would never have seen puberty blockers dished out willy-nilly to children and young people in this vulnerable patient group. I have sought at all times, including when I sat on the Opposition Benches, to treat this debate with the care, sensitivity and humility it deserves, and not to be tribal in my interactions. I only wish this Conservative Opposition would take the same approach.

[Madam Deputy Speaker]

We are only at the start of this urgent question, so I ask Members to reduce the temperature in the Chamber.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

I thank my right hon. Friend for the care and sensitivity he has taken to this subject all along. It has been an undeniably difficult year for transgender people in Britain. I have spoken to young trans people who have been pushed to the brink of suicide by what they hear—that they do not have a right to exist, that they do not deserve rights, that they are legitimate targets for ridicule. We all in this House have a responsibility to lower the temperature and focus on their welfare, health and dignity.

King’s College operates the highest standards of safety. Does the Secretary of State agree that its expertise and rigour will support the wellbeing of participants and ensure that we get the robust evidence we need and that vulnerable children are no longer treated as political punchbags?

--- Later in debate ---

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I ask colleagues to keep their questions short and the Secretary of State to keep his responses on point. I call Health and Social Care Committee member, Josh Fenton-Glynn.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

I hope we can all agree that the young people involved should not be used by anyone as a political football. Can my right hon. Friend please assure me that the process and trial will be clinically led, not defined by rhetoric—in this place or anywhere else?

--- Later in debate ---

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. If hon. Members do not keep their questions short, I will not get everybody in. The answers need to be just as short.

[Wes Streeting]

I will try to do that, Madam Deputy Speaker.

We will ensure that young people get good access to wider evidence-led support. I have had to wrestle with the fact that some trans people enter adulthood without ever receiving any sort of healthcare, and I have been heavily criticised by those people in particular for some of the decisions that I have taken. We are working to reduce waiting times, as I have described.

My hon. Friend says that puberty blockers are reversible. We hear contrary views about that from Members across the House, some of whom say that puberty blockers are irreversible. The truth is that the evidence in this area is mixed, which is why we need to build a stronger evidence base.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

We need a short question. I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

May I thank the Secretary of State for all that he does? He deserves credit. A mother from my constituency phoned me this morning and said:

“Why is money being spent on this pathway when my child has been waiting for clinical support for 3 years and the waiting list is so long she may be moved to adult treatment? Why is Government prioritising the tiny few over the many? With our children’s mental health services at breaking point and parents at their wits end trying to get their child diagnosed”,

how do the Government look in the eyes of the parents with rare diseases whose drugs are not funded by the NHS when they are funding this trial?

[Several hon. Members rose—]

[Madam Deputy Speaker]

I call Samantha Niblett for a short question.

[Samantha Niblett (South Derbyshire) (Lab)]

Trans people do not wake up at 18 suddenly trans; it starts before then. When we talk about protecting children, it means protecting trans children so that they can transition into adulthood knowing that they had parents and doctors who advocated for their needs. But this trial is not a prison sentence, so will the Secretary of State talk about whether people are entitled to withdraw from it if they change their mind?