Hansard

I start by speaking directly to our young people—in particular, our trans and non-binary young people across Scotland. I know that the past few weeks and months have been incredibly difficult, with increased media attention and toxic online commentary. I understand how shocking, upsetting and destabilising the announcements last week, and the public conversation around them, will have been for you and your families. I want to reassure you that the Scottish Government remains absolutely committed to not just ensuring that on-going support is available for you but reforming and improving gender-identity healthcare. That was a key part of the Bute house agreement, and we will not waver in that commitment.

Before I continue, I make it clear that, as a Parliament, we have a responsibility to protect and support minority groups. We are all human beings; we are all individuals; and we all deserve respect. It is vital that we lead by example in the tone of our discussions, and I hope that that will be reflected in today’s session. I reiterate what the First Minister has clearly said: the Cass review is a detailed piece of work that requires thoughtful consideration.

Last Thursday, NHS Greater Glasgow and Clyde and NHS Lothian—the two health boards in Scotland that have specialist paediatric endocrinology services—issued a joint statement confirming a pause on new prescriptions for puberty hormone suppressants and cross-sex hormone medication for young people with gender dysphoria. That pause is to allow time for further evidence to be gathered to support the safety and clinical effectiveness of those medications, following the Cass review. The statement also confirmed that the small number of young people who are currently receiving those medicines will not be affected by that pause. That mirrors the position in NHS England.

As I have said consistently, it is not for politicians or civil servants to make clinical decisions about clinical pathways. Such decisions should always be made carefully, be based on the best evidence available, and be made only by the clinicians responsible for providing such healthcare. To be very clear, ministers do not make clinical decisions in any field of medicine, and that of gender-identity services is no exception. I fully support health board autonomy in clinical decision making.

The commitment of clinicians to their patients in those services, alongside their wider multidisciplinary teams, is unwavering. Their focus is always on ensuring that the treatment that they prescribe is safe. Too often, they face vitriol simply for doing their job, and it is important that they, too, are supported.

Some members have expressed disappointment that the Scottish Government did not announce the position before the health board statement. Every one of us in the chamber—indeed, every one of us across Scotland—has a right to hear first and directly from the services that care for us if our treatment for any health matter is going to change. That is why it was absolutely correct that, before making a public announcement, NHS Greater Glasgow and Clyde and NHS Lothian took the time to speak to all the young people who would be impacted by the pause, so that they understood what it meant for their care and treatment.

I am sure that everyone in the chamber will agree that, if this were happening to their loved one, that is exactly what they would want, and expect, to happen. I reiterate: those young people and their families must be at the heart of our decisions and thoughts when we discuss this issue. The NHS Greater Glasgow and Clyde young people’s gender service in Scotland remains absolutely committed to providing the best quality care for patients, and referrals. The service will continue to provide holistic care and support to those accessing it and referred to it.

The Cass review is a detailed, wide-ranging report, and I welcome the opportunity to update Parliament on our approach to the recommendations and on the wider work in that field. It is important to highlight that the Cass review was commissioned by NHS England and did not review clinical services or pathways that are provided in the national health service in Scotland. Therefore, by definition, not all the recommendations may be applicable to NHS services in Scotland. That said, it is vitally important that the recommendations are carefully considered to assess the extent to which they are relevant to the approach to gender-identity healthcare in Scotland, and that we decide upon what steps might need to be taken as a result.

Time is required to fully consider all the recommendations, which NHS England also acknowledges. We already have a strategic action framework for the improvement of NHS gender-identity services. As part of that work, the chief medical officer has agreed that the deputy chief medical officer and other senior medical officers will support careful consideration of the Cass review’s clinical recommendations and engage on them with the Scottish Association of Medical Directors and other clinical leaders. A multidisciplinary clinical team within the office of the chief medical officer in the Scottish Government—including people with paediatric, pharmacy and scientific expertise—will assess the clinical recommendations and engage with the relevant clinical community and leadership in health boards in relation to the recommendations. The CMO will provide a written update to Parliament on the outcome of that clinical consideration process before the summer recess.

It is important to note that, in Scotland, we are already making progress on a number of aspects of gender-identity healthcare that are highlighted in the Cass review. Let me be clear that work has already begun, and I will remain engaged throughout. Dr Cass highlighted the need to address increased capacity in services. The Scottish Government has committed to investing £9 million to support the improvement of NHS gender-identity healthcare in Scotland. That funding will be delivered during a five-year period, so the national improvement work that is already under way will be embedded and built on. That aligns with feedback that has been received from health boards and third sector stakeholders regarding the need to support longer-term sustainability of service improvement.

Since December 2022, we have invested more than £2.8 million to support work to improve access to gender-identity healthcare in Scotland, with more than £2.2 million of that allocated directly to health boards with gender-identity clinics. We will invest a further £2 million this year and a further £2 million in each of the next two years, and we are committed to long-term sustainable funding for those services beyond that point. We are also working with NHS Greater Glasgow and Clyde and NHS National Services Scotland to establish a nationally commissioned young people’s gender service, which is part of ensuring that young people’s gender care in Scotland is as person centred and effective as possible.

The Cass review recommends that gender-identity healthcare must operate to the same standard as other clinical services. We agree. We have already commissioned Healthcare Improvement Scotland to develop new national standards for gender-identity healthcare, and those standards are expected to be published this summer.

A key focus throughout the review is the need for better high-quality evidence in this field, and we agree. Long before the publication of the Cass report, we provided the University of Glasgow with grant funding to establish a programme of research into the long-term health outcomes of people accessing gender-identity healthcare. That now includes six projects in which the health outcomes of adults and young people are considered, covering cardiovascular health, hypertension, sexual health, mental health and longer-term wellbeing. The outputs of those projects are expected towards the end of this year. In addition, the Scottish Government and Scottish health boards are observers to NHS England’s planned study into the use of puberty blockers in young people’s gender-identity healthcare, and discussions are on-going to determine what further involvement is appropriate.

It did not take the publication of the Cass review for us to start a broad programme of work to improve gender-identity healthcare. In addition to the work that I have already highlighted, we have commissioned Public Health Scotland to develop a quarterly aggregate data collection for NHS gender-identity clinic waiting times, and we are supporting NHS National Education Scotland to develop new training materials for staff. Importantly, throughout that work, we have engaged with trans and non-binary people across Scotland who have lived experience of accessing, or waiting to access, gender-identity services in order to ensure that their voices are represented in our work to improve such care.

Building on that, and in response to the understandable concern from those who are impacted both by this change and, more broadly, by the provision of gender-identity healthcare to young people, we will hold a round table with stakeholders representing those affected, and I will continue to engage directly with young people.

I understand how difficult and heartbreaking the announcement last week will have been for the small number of young people and their families who were anticipating that they would soon be able to start these treatments. Dr Cass reminds us in her report that

“a compassionate and kind society remembers that there are real children, young people, families, carers and clinicians behind the headlines”.

I hope that we can all keep in mind that sentiment, today and as we move forward.