PARLIAMENTARY DEBATE
Cass Review - 15 April 2024 (Commons/Commons Chamber)

With your permission, Madam Deputy Speaker, I would like to make a statement on the Cass review of gender identity services for children and young people. May I say how pleased I am that we are joined by parents of children who have been affected by some of the issues raised in this review? I hope all of us will bear the sensitivities of this debate in mind as we discuss it this afternoon.

This review strikes hard and sure at an area of public policy where fashionable cultural values have overtaken evidence, safety and biological reality. This must now stop. As recently as 2009, the NHS’s sole gender identity development service at the Tavistock and Portman NHS Foundation Trust received fewer than 60 referrals for children and young people, and just 15 for adolescent girls. Since then, demand has surged. By 2016, over 1,700 children and young people a year were referred—a 34-fold increase. More than half were teenage girls. In 2022, more than 5,000 children and young people were referred to gender identity clinics, and almost three quarters were female.

This exponential increase in demand is not a coincidence; it has been driven by a number of factors which I will come to later, but at its heart it was driven by a myth. This myth was that for children and young people grappling with adolescence who were questioning their identity, their sexuality or their path in life, the answer to their questions was inevitably to change gender to solve their feelings of unease, discomfort or distress.

That near-uniform prescription was imposed on children and young people with complex needs without full and thoughtful consideration of their wider needs, including, as is set out in the report, conditions such as neurodiversity, experiences such as childhood trauma or mental health conditions, or indeed discovering who it is that they may one day fall in love with. Indeed, the response from some of the people who should have protected them—some of the clinicians in charge of their care at the Tavistock clinic—was almost always to put them on an irreversible path: blocking puberty, then prescribing cross-sex hormones, and on to surgery as an adult. In other words, such professionals were not asking the right questions of themselves or of their patients.

That is why in 2020, with the support of my predecessors, my right hon. Friends the Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sir Sajid Javid), NHS England commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. I would like to start by thanking Dr Cass and her team for undertaking a considered, comprehensive and courageous review into an extremely contentious area of healthcare. Since NHS England commissioned the review in 2020, they have meticulously unpicked what went wrong, what the evidence really shows and how to design a fundamentally different service that better serves the needs of children.

I must also thank those who raised the alarm and contributed to the review over the last four years: the clinicians who spoke up against their peers to blow the whistle about what was happening at the Tavistock clinic, even though it risked their careers; the journalists, academics and activists who listened to their stories and investigated further, even when they were derided as bigots and transphobes; the parents who were just trying their best to support their children, but were so badly let down by a service that vilified them for questioning whether the interventions offered were right for their children; and, of course, the young people themselves who have shared their experiences, including those who have gone through the pain of de-transitioning only to find out that the so-called “reversible” treatments they were offered are not in fact reversible.

The Cass review makes for sober reading. It is extremely thorough, so I will not attempt to cover all its recommendations today, but I genuinely encourage all Members to read the report in full. It should concern every single Member of this House that part of our public space—the NHS—was overtaken by a culture of secrecy and ideology that was allowed to trump evidence and safety. We say enough is enough; our young people deserve better, and we must do whatever it takes to protect them.

Since the publication of Dr Cass’s interim report in 2022, a series of important changes have been made, and I put on record my thanks to NHS England’s chief executive, Amanda Pritchard, and all those at NHS England who have worked hard with Dr Cass to implement them. On 31 March, the Tavistock clinic finally closed, having stopped seeing new patients a year earlier. Two new regional hubs have been opened, in partnership with the country’s most prestigious children’s hospitals, to ensure that children are supported by specialist, multidisciplinary teams. Indeed, another hub will follow in Bristol later this year.

In the past few weeks, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. On the day of publication of Dr Cass’s final report, it announced that it is stopping children under 18 from being seen by adult gender services with immediate effect, and an urgent review on clinical policy for cross-sex hormones will now follow without delay. I also welcome NHS England’s plans to bring forward its full review of adult services, including Dr Cass’s recommendation for a follow-through service for young people up to the age of 25.

I also share Dr Cass’s concerns that clinicians who subscribe to gender ideology will try to use private providers to get around the rules. Let me give a very clear warning: prescribing is a highly regulated activity, and the Care Quality Commission has not licensed any gender clinic to prescribe hormone blockers or cross-sex hormones to people under the age of 16. Any clinic that does may be committing extremely serious regulatory offences for which its licence can be revoked and its clinicians can be struck off. My officials have been in contact with the CQC following the final report to ask that it looks again at the age thresholds in its licensing conditions.

The CQC has also reassured us that it will incorporate Dr Cass’s recommendations into their safe care and treatment standards for all care providers. That means that all new providers will be asked if their practices respect the Cass review, and all existing providers have to meet the same rigorous standards when they are reviewed by the CQC. My officials met the General Medical Council over the weekend, and will do so again in the coming days, to understand how it will ensure that every clinician on its register follows its code of practice and implements the wider findings of the Cass review.

It is morally and medically reprehensible that some online providers not registered in the UK have stated their intention to continue to issue prescriptions to children in this country. I am looking closely at what can be done to curtail any loopholes in prescribing practices, including legislative options. Nothing is off the table, and I will update the House in due course as we progress that work at pace.

Dr Cass also found that there was a lack of robust data on what happened to the 9,000 children who were treated by gender identity services between 2009 and 2020. Many went on to continue their treatment at adult clinics, and the University of York had been due to research the long-term consequences of treatment they received as children, so that we can properly support them through their journey into adulthood. It was expected to provide important insights into the clinic’s work, including how many patients de-transitioned and how many were also diagnosed with a mental health condition or an autism spectrum disorder.

This Government took the unprecedented step of changing the law to make it possible for adult gender clinics to share medical data with the university. All bar one of the adult gender clinics refused to co-operate with this vital research. To quote Dr Cass, that is “unacceptable”, but I would go even further: I think it is deplorable and a dereliction of their professional duty. I am pleased to update the House that following the publication of Dr Cass’s report, I have been informed that all seven clinical leads for the adult gender services now intend to fully participate in this important work.

Dr Cass also concludes that a cultural shift alone “does not adequately explain” the huge growth in young women being referred to gender services. She paints an alarming picture of digitally engaged young women who are frequently exposed to pornography involving violent, coercive, degrading and pain-inducing acts. Is it any wonder than more and more of them are looking for ways to opt out of becoming women? That is deeply troubling and, as Dr Cass makes clear, we have a duty to support those young women with considered, evidence-based care.

Our children deserve healthcare that is compassionate, caring and careful. Their safety and wellbeing must come above any other concern, and anyone who threatens it must be held to account. I will work with NHS England to root out the ideology that has caused so much unnecessary harm, to support those who have already received life-altering treatment, to give the next generation access to holistic care, and to protect our children’s futures. Anything less would be neglecting our duty to the next generation. That will not happen under this Government, and it will not happen under my watch.

I welcome all those who have changed their minds about this critical issue. In order to move forward and get on with the vital work that Dr Cass recommends, we need more people to face up to the truth, no matter how uncomfortable that makes them feel. I hope the hon. Gentleman has the humility to understand that the ideology that he and his colleagues espoused was part of the problem. He talked about the culture and the toxicity of the debate. Does he understand the hurt that he caused to people when he told them to “just get over it”? Does he know that when he and his friends on the left spent the last decade crying, “Culture wars,” when legitimate concerns were raised created an atmosphere of intimidation, with the impact on the workforce that he rightly described? People were scared or worried to go into it.

Does the hon. Gentleman now have the good grace to apologise to those who have been maligned in public life—including his own female colleagues—and for the chilling effect that this has had on clinicians, journalists and campaigners who were trying to raise the alarm? I say that because I want to believe the hon. Gentleman when he says that he has turned a corner on this issue. We have to start with a new page, for the sake not just of the children and young people we are looking after but of their families, many of whom will be watching this, living with the consequences of the ideology and secrecy, wondering how on earth the hon. Gentleman talks about general elections when, every single minute and day, their children have to live with treatment that can never be reversed.

I thank my hon. Friend, who in her parliamentary career has done so much to shine a light on this sort of behaviour. She has espoused worries, both publicly and privately, about the children and young people at the heart of this matter. Looking to the future, the Tavistock clinic has shut. As I said, it stopped admitting patients a year ago. The new services that are already in place—the two new hubs, with plans to expand further across the country—are about ensuring a multidisciplinary approach to young people, so that, with exactly the experiences Dr Cass sets outs so starkly in her report, children are treated as human beings and patients, not as siloed conditions. One of the main problems that emerged with the Tavistock behaviour and the way it took place is that gender questioning was siloed in a way that no other health or mental health condition was. We want to move back to a place where clinicians are no longer scared of looking after children and young people with these issues, and that they see it as part of their general practice and general work. That is how we are best going to address the very complex needs of many of these children and young people.

I encourage both the Scottish National party in Scotland and Labour in Wales—health is devolved in those countries, of course—to respond as quickly as possible to the findings of the review. The hon. Lady asks whether it is Barnett-ised. For these purposes, our work to ensure that the clinics meet the needs of our population in England is not additional money. We are re-prioritising within NHS budgets to ensure that the services are spread across the country. I encourage the Scottish nationalists to prioritise the needs of their children and young people in the same way.

I would also gently make the point that, when it comes to the atmosphere of this debate, I do not believe it has been helped by the SNP’s highly controversial Hate Crime and Public Order (Scotland) Act 2021. I note, for example, the behaviour and engagement on Twitter of very high-profile people in Scotland, and the impact that it has had when people have dared to name activists in this arena. I would also ask the Scottish Labour party to explain why it helped the SNP to pass that Act, because to me this seems to be all about the atmosphere.

My right hon. Friend is right to identify the cohort of young people between the ages of 17 and 25 as being of particular concern. Now that we have a clear pathway in relation to the treatment of children and young people under the age of 17, I have asked NHSE to focus primarily on that next cohort. Speaking to parents gives one a very real sense of their concerns about what they describe as the cliff edge between children and young people’s services and adult services for this very vulnerable group of young people. I do not want that to continue, and over the coming months we will see NHSE develop work to help that cohort.

My right hon. Friend has an understanding not just of how transformational the report and its evidence are, but of the challenges that this means for our health service in England and how we choose to respond. As for funding, NHSE has committed more than £17 million to the two new hubs in the current financial year, and I hope and expect that our devolved Administrations will commit similar sums to looking after children and young people in their areas.

As I have said, we hope to expand it to Bristol later in the year, and there will be a further three or four sites across England. However—this is a really important part of the report—this is not just about specialist services but about giving clinicians the necessary confidence to look after children and young people who may well be presenting at their clinics or surgeries with this condition as one of a number of conditions. We want to give them back that confidence, and the comfort of knowing that they need not just go down the narrow pathway of specialist services. Of course that will be appropriate for many, but we want to treat the whole child rather than treating just this particular condition, as has happened in the past.

I am extremely grateful to my hon. Friend for bringing her clinical expertise and experience to the Chamber and to this important debate. As for her precise questions about who did what and when, I hope she will understand that I have been working at pace on this report over the last few days; I have asked these questions myself, and I will update the House when I am in a position to do so.

Let me return the House’s attention to the expectation, not just moral but professional—in the light of the report and the evidence that it has produced—that clinicians and other medical professionals will act in accordance with these recommendations. That will mean that when regulators examine the conduct of medical professionals, they do so against this backdrop and in the context of these expectations. If there are people who are operating under the misguided apprehension that their ideology trumps the evidence, I fully expect the regulators to crack down on that.

I come to the Dispatch Box with huge admiration for the hon. Lady for the commitment that she and other Labour Back Benchers have shown, in a culture and an atmosphere in which their views were demeaned and they were sneered at and castigated. Indeed, I hear rumours that efforts were made to remove certain Members from the party itself. This is the moment for apologies and for humility, but also for us to start a clean page and ensure that, when perfectly reasonable questions are asked about the medical treatment of our children, those questions are allowed to be asked in an atmosphere of respect and understanding, so that these vulnerable children and young people are looked after in a caring and careful way.

As my hon. Friend was asking that question, there were people on the Opposition Benches tutting her. That shows that while some understand the need to keep the debate about the clinical needs of these children and compassion, there are still people on the Opposition Benches who do not get it. For example, in 2020 the deputy leader of the Labour party signed a charter describing bodies such as Woman’s Place UK, which, dare I say, campaigns for single-sex rape refuges—to which the House knows I have an enormous commitment—as “trans-exclusionist hate groups”. That sort of language needs to be apologised for, so that we can all move on. We expect clinicians and medical professionals to do the right thing by the Cass report, and by our children and young people. There needs to be some leadership from all of us in public life to ensure that we set the right example to those people.

I thank the hon. Lady, who has an exemplary record of campaigning on this issue. This comes down to the very careful review by Dr Cass. We have to get away from the idea that if a child presents with gender distress, that is the only part of their health that we should care about and look into. We have to look across the board to ensure that we look after every single part of them and do not assume that medical pathways are the only and inevitable pathways for them. One of the concerns raised in the report is that the terrible mental health issues that many children and young people were suffering from were not being looked after. People were just put on drugs and expected to get on with it. That is wrong, and we are determined to change it.

This is not about my emotions, but I can tell my hon. Friend that I was disgusted and angry. What is more, this is about being able to have conversations in our public space. For example, if our public institutions—whether it is the NHS, schools or whatever—are asked to respond to a thoughtful and careful review such as the Cass report, they must do so, because this information does not belong to them; it belongs to their patients, to future patients—because we want to shape services to help them—and to us as a nation. I welcome such institutions’ about-turn in deciding that they will provide the data. I am pleased that has happened, but my goodness me, I wish they had done it earlier.

I am not clear whether the hon. Lady supports the report or is castigating it; I have no idea whether she supports it or not. We are trying to use the evidence in this very thorough and thoughtful review, in the words of her Front-Bench spokesman, to help clinicians treat our young people and children in a compassionate, caring way. I have noticed, and have had it reported to me by others who have been watching, that certain campaigners are trying to build up a head of steam to say that the report is somehow flawed. It is not. This is superb evidence, and the NHS has assured us that it will act on it.

I thank my hon. Friend for his question. We want to not just help with crisis support, but prevent our young people from getting into a position of crisis in the first place, so we are rolling out mental health support teams, ahead of our schedule, across schools. That is a really important piece of work that will help 44% of the student population, but we want to go even further. In the 12-month period ending in March 2021, we increased the number of children and young people aged under 18 who received NHS-funded mental health services to some 758,000.[Official Report, 13 May 2024; Vol. 750, c. 2WC.] (Correction) Of course, we want that support to be there in the community, but importantly we also want to help clinicians to understand that this is just one of several sets of conditions that they should have confidence to work on, in order to look after the child holistically.

The reason why I am able to be so robust on this issue is that I believe in it; on that, I may be different from others. The challenge that the right hon. Gentleman rightly puts forward is that we have to ensure that NHS England acts as an organisation, but also at the individual and local levels, to implement the reforms that the report recommends. I want to be fair to clinicians, medical professionals, managers and others who very much support the review. I want to support them in taking up the recommendations. What individual clinicians may or may not have done in the past will be a matter for both NHS England and the regulators going forward. The moral and professional expectation is that in future, clinicians, medical professionals and all of us will respect the evidence and the recommendations of this important report.

I thank my hon. Friend sincerely for her help in raising these difficult questions and for doing so, as she has just demonstrated, in a thoughtful and careful manner. I know that she shares my concern that the children and young people at the heart of this should be our focus. We need to build the system around them, rather than them being slotted into the system, as has happened in the past.

On conversion therapy—again, I am being very mindful of the sensitivities of this—we are committed to supporting all victims of conversion practices, but we want to avoid any unintended consequences and ensure that the draft Bill takes account of the independent Cass review. That is why my Cabinet counterpart, the Minister for Women and Equalities, is leading the work in this area. We are very much considering this complex issue as part of our approach to this sensitive and important matter.

Again, I approach the Dispatch Box with humility because I know about the journey that the hon. Lady has been on, and about the debates and questions that she has brought forward, not just on behalf of the constituent that she mentions, but on the wider issue of the treatment of women in healthcare and in other parts of public life. I very much want us to view the future as a clean sheet, so that we can build services around children, rather than expecting them to slot into services for the convenience of arguments that were put forward in the past.

However, we have to acknowledge that this has been such a long and toxic debate that there will be people who want answers. I appreciate the fact that the hon. Member for Ilford North (Wes Streeting) has walked back some of his comments, but it is important that we acknowledge the toxicity, so that we can move on and achieve exactly what the hon. Lady and I, and others around the Chamber, seek. [Interruption.] Interestingly, Opposition Members are chuntering from sedentary positions. I think that we can make a real change, but a little less sniping from the sidelines and a little more constructive work is needed.

I thank my hon. Friend for his powerful question. I am going to deal, if I may, with his point about a public inquiry, because I know that there are some who are asking whether that would be appropriate. Will my hon. Friend take it from me that, at the moment—bearing in mind that the report landed less than a week ago—I am determined to drive forward the actions that are needed on the ground to help children and young people? We have had a four-year review into this—Dr Cass has gathered a great deal of evidence and it is a very thorough review—and so, for the moment, I want to concentrate on implementing the recommendations and on ensuring that the services are brought up to the standards that my hon. Friend rightly understands.

On my hon. Friend’s second point, of course I will liaise with my colleagues in the Department for Education. This is about helping all public sector professionals to ensure that they are acting on the evidence, as set out in the Cass review, for the sake of our children and young people.

I am conscious that I have just answered that, but may I put on the record my thanks and respect for everything that the hon. and learned Lady has done in this field? She has at times had to walk a very, very lonely path, and I find it extraordinary that parliamentarians—who are elected to represent the best interests of our constituents, and indeed of our countries—would find themselves under that sort of pressure for simply stating biological fact. I hope that the hon. and learned Lady will be working with me to ensure that the recommendations in the Cass review are applied not just in England but in Scotland, in Wales and in Northern Ireland.

This report sets out the evidence, which was not there before. It has taken four long years of very hard work to gather that evidence, and I hope and expect that the health sector will implement these recommendations. I also hope we can have a conversation about our wider public space, and I was very pleased to read the article by my right hon. Friend the Minister for Women and Equalities over the weekend. We have to de-politicise the public space and ensure that this evidence is applied across the board for the health of all our constituents and our country.

I am sorry, but I think there is a certain amount of disbelief in the Chamber. I cannot be the only one who remembers the debate on the Gender Recognition Reform (Scotland) Bill in January 2023 when the hon. Gentleman not only tried to shout down female Opposition colleagues but felt so exercised that he crossed the Floor of the House to sit next to my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates). I remember how Conservative Members were genuinely surprised that a Member of Parliament would think it appropriate to behave in that way when debating a subject that we are entitled to, and should feel free to, debate. I am sorry to hear that the hon. Gentleman suffered the abuse that he describes, but setting a good example starts at home. I hope he will never again behave as he did in the Chamber that day, because that is how we sort out the toxicity of this debate.

I thank my hon. Friend for his careful and considered question. I very much hope that the Scottish National party Government will look at the evidence very carefully and find the recommendations to their liking. It is to NHS England’s credit that it has acted so promptly, and I would hope and expect that the devolved nations, let by the Scottish National party and the Welsh Labour party, will follow with similar speed.

As I have had to say, because it is in line with the atmosphere in which clinicians are having to operate, the Hate Crime and Public Order (Scotland) Act 2021, brought forward by the Scottish National party Government and supported by Scottish Labour, cannot help the considered debate that we wish to have about this very complex subject, and I encourage them to look at that as part of their overall approach.

True leadership is not just about being careful with the words we use. I will not recite the many words that other Labour Members have used about trans issues. They say, for example, that it is factually inaccurate to say that only women have a cervix—[Interruption.] I am not naming them, but that seems an extraordinary things for a Labour Member to say. [Interruption.] They do not like to hear their words repeated back to them, but I will resist that temptation and instead focus on the application of policy.

Trans prisoners, including those who are fully intact and have been convicted of serious sexual offences, are demanding to be held in prisons that match their chosen gender. This Government, including me and many of my predecessors as Prisons Minister, set clear rules to ensure that situations such as the Karen White case are not repeated, so it was very troubling that Opposition Members did not appear to have the same concerns when it came to the placing of a trans double rapist, Isla Bryson, in Scotland. [Interruption.] I am being told that it is not true but, if Opposition Members want to factcheck, apparently it was the deputy leader of the Labour party who said that it does not matter.

The brevity of my answer demonstrates my respect for the observations and experience of my hon. Friend the Member for Stone (Sir William Cash). I completely agree with him, and I will enjoy working with him on this.

I thank the hon. Gentleman for his advocacy on this issue. I very much hope that all Members will be able to use the evidence produced in this review and report in future debates about legislation so that we can all make informed and correct decisions.

I thank my hon. Friend and near neighbour for that. She is right, as is my hon. Friend the Member for Stone (Sir William Cash), to emphasise that this is about not just the debate within the NHS, but what happens online. I know that parents of children affected by this are very aware of the online “grooming”, as they describe it, of children on social media. I do not want to trespass for the time being on the regulators—we have already had some constructive conversations with them—but the will of the House is clear that we expect the report to be followed and clinicians to act on the basis of that evidence.

I thank the hon. Lady for her thoughtful question, because she rightly lists some of the mental health conditions that both Dr Cass and professionals in this area have realised can be part of the complex needs of children and young people who are asking questions of their identity and about their path in life. On funding, the financial value of the contract last year with the Tavistock was £9.3 million, but for this financial year NHS England has committed some £17.1 million for the two new hubs for gender services. Of course, they will keep this under review as we build up the services across the country in the ways envisaged in the report.

I completely understand my hon. Friend’s desire for accountability. I just remind us all that some clinicians have acted in a morally exemplary way, trying to blow the whistle on practices they observe. He and I, and, I hope, others, want to ensure that clinicians who have not acted in accordance with their professional duties are held to account. As I say, ongoing conversations are taking place with the independent regulators, but I suspect that they have very much understood the way in which the House is viewing this and the seriousness with which we view clinicians who have not abided by their professional duties in this regard.

I hope the hon. Lady will forgive me if I have misunderstood her question, but I think she is referring to the decision that NHS England will prevent under-18s from accessing adult gender services. A consultation has just closed and we are looking at the results of that, but I am very sensitive to the needs of young people within that 17-to-25 cohort for whom the “cliff edge”, as it has been described to me, of moving from children’s services to adult services may not be in their best interests. I promise that that is very much the focus of my work on this in the weeks ahead.

I thank my hon. Friend sincerely for that. Again, she articulates the concerns of many families where a teenager or young person may be suffering complex needs and are asking questions of themselves and their place in society. We must treat not just the child or young person, but the family with care and respect, trying to support them to get to the right place for the child.

I thank the hon. Lady for giving me the opportunity to make it clear again that this report is about gathering the evidence to help support our children and young people to the best care they can have. For a very small number that may well be a medical pathway, but for the overwhelming majority we know from Dr Cass’s report that there may be other ways in which they can be best supported and looked after. I do not want anyone to walk away from this debate thinking that this is somehow a report about those adults who have made that decision of their own free will and are living their lives as freely as we all want them to—it is not. It is about the healthcare and emotional care and support that we give to young people and their families, and the professional confidence we give to clinicians to ensure that we get to the right place for each and every individual child.

My hon. Friend’s observations about Members from other parts of the Chamber and their response to this are well made, frankly. [Interruption.] Gosh, I am being told they are not true. Crikey, Opposition Members may have just opened up a Pandora’s box. On my hon. Friend’s point about supporting people who have gone through the process and are trying to detransition, she is absolutely right that they need particular care. I am actively looking into what NHS England needs to provide to look after the very complex needs that such people have.

I genuinely thank the right hon. Gentleman for giving me the chance to re-emphasise that. When I have talked about ideology, it is the ideology influencing or making assumptions about the provision of services for any child or young person who is questioning their place, sexuality, identity or future path in life. The ideology is the one that influenced the services that Dr Cass has set out so very well. Of course, if an adult chooses to live their life as a transgender adult then they must do so freely, and, I would hope, with compassion and understanding from all of us. By the way, I have been talking about this for many years; when I was Minister for Women, I talked about this subject. We must deal with this issue in a caring and careful way, and that is what Dr Cass emphasises in her report.

I very much agree with my hon. Friend. He is always very good at exposing the differences in treatment that patients in Wales receive compared with those in England. Given that the leader of the Labour party has said that Wales is the “blueprint” for how it plans to run the NHS in England, I hope and expect that the Labour party will be true to its word and the Labour-run NHS in Wales will be announcing its immediate adoption of these recommendations, as well as the transformation to services that we in England are already undertaking.

I refer the hon. Lady to the answer I gave earlier about funding. In relation to the waiting list, we have already removed the Tavistock as the single provider of these services. We have now set up two sets of services in highly respected—world-respected—children’s hospitals, and we will add more. Again, the issue goes back to giving GPs and other practitioners the confidence to look after these children as they would if they were presenting solely with, for example, ADHD symptoms or concerns about mental health. This is about saying that this issue is one part of the patient they must treat, not isolating and siloing it in the way that has happened historically.

I thank my hon. Friend, and I will set out the practical and important steps NHS England has already taken, which I hope other parts of the United Kingdom will follow. NHS England has banned the prescription of puberty blockers for gender dysphoria to children under the age of 18. On the advice of Dr Cass, cross-sex hormones can be prescribed only with extreme caution for those aged 16 and older. No cross-sex hormones may be prescribed to those under 16 for gender dysphoria. There are medical caveats to that for other medical conditions, and we need to be very careful about unintended consequences, which is why this is such a complicated piece of work. We want to ensure that these drugs are prescribed to the right people, if they should be prescribed at all.

On my hon. Friend’s point about campaigning organisations, part of our collective frustration is that our public spaces have become politicised. I would say there is no space for that sort of campaign activity in any of our public institutions. I appreciate that a range of views must be represented. Young people must be helped to discover their path in life, their sexuality and all of the things that are such a wonderful part of growing up, but we have to do so in a way that is fair and rigorous, and does not give way against the evidence into the realms of ideology, which sadly we have seen in some instances.

If the hon. Gentleman wants to work constructively with me on ensuring that we deal with this report and the evidence in a caring and careful way, for the benefit not just of children and young people but of the wider trans community, I would welcome his support in so doing.

Not only have I tried to espouse those principles in every ministerial role that I have held, but it is the guiding light of this Government to try to ensure that we get the right healthcare and support to patients as quickly as possible. We also want to ensure that we are treating not just the condition, but the patient as a whole. As some of the complexity of the debates that we had this afternoon shows, young people are at the very heart of this. I think this is the final question, Madam Deputy Speaker, so I will end with the young people that we are concerned about. [Interruption.] I am so sorry; I have one more question from the hon. Member for Strangford (Jim Shannon). The children and young people who are the focus of this report have to be, and will be, the focus of our work going forward. We want to get the right services to the right children at the right time.

Let me offer the hon. Gentleman my sincere apologies; I am out of practice and should have known that his would be the last question.

I genuinely look forward to working with my Northern Irish counterparts on this, as we have already worked together on other matters. The hon. Gentleman makes a point about private practices. That is one area that I am working on at pace. What we do not want is to have any idea forming that somehow people can get round the strict rules that the NHS is setting the system to get these drugs to young people and children. I promise to come back and update the House when I have more news on that, but the hon. Gentleman is right to identify that issue. It shows the complexity of the matter and the real need for a very clear, detailed and principled approach to help reform our NHS so that we make it faster, simpler and fairer.