Public Health and Women's Health Minister Jenni Minto

The Scotsman

Public Health and Women's Health Minister Jenni Minto delivers a statement after the prescription of puberty blockers to children was paused by NHS Scotland

Transcript

00:00The next item of business is a statement by Jenny Minto on gender identity healthcare

00:06for young people. The Minister will take questions at the end of her statement, so there should

00:10be no interruptions or interventions.

00:13I call on Jenny Minto, Minister. Up to 10 minutes, please.

00:19I want to start by speaking directly to our young people and, in particular, our trans

00:24and non-binary young people across Scotland. I know that the past few weeks and months

00:30have been incredibly difficult, with increased media attention and toxic online commentary.

00:36I understand how shocking, upsetting and destabilising the announcements last week and the public

00:41conversation around them will have been for you and your families.

00:46I want to reassure you that the Scottish Government remains absolutely committed not just to ensuring

00:52that on-going support is available for you, but to reforming and improving gender identity

00:57healthcare. That was a key part of the Bute house agreement, and we will not waver in

01:03that commitment.

01:05Before I continue, I am clear that, as a Parliament, we have a responsibility to protect and support

01:11minority groups. We are all human beings, we are all individuals and we all deserve

01:17respect. It is vital that we lead by example and the tone of our discussions will be reflected

01:25in this session.

01:28Let me reiterate what the First Minister has clearly said. The cast review is a detailed

01:33piece of work that requires thoughtful consideration.

01:38Last Thursday, NHS Greater Glasgow and Clyde and NHS Lothian, the two health boards in

01:43Scotland with specialist paediatric endocrinology services, issued a joint statement confirming

01:49a pause on new prescriptions for puberty hormone suppressants and cross-sex hormone medication

01:55for young people with gender dysphoria. That pause is to allow time for further evidence

02:01to be gathered to support the safety and clinical effectiveness of those medications following

02:07the cast review.

02:08The statement also confirmed that the small number of young people who are currently receiving

02:13those medicines will not be affected by that pause, mirroring the position in NHS England.

02:20As I have said consistently, it is not for politicians or civil servants to make clinical

02:25decisions about clinical pathways. Those decisions should always be made carefully, be based

02:32on the best evidence available and be made only by clinicians who are responsible for

02:37providing such healthcare. To be very clear, ministers do not make clinical decisions in

02:43any field of medicine, and gender identity services are no exception. I fully support

02:49health board autonomy in clinical decision making.

02:52The commitment of clinicians to their patients in those services, alongside their wider multidisciplinary

02:58teams, is unwavering. Their focus is always on ensuring that the treatment that they prescribe

03:04is safe. Too often, they face vitriol simply for doing their job, and it is important that

03:10they are supported, too.

03:13I know that some members in the chamber have expressed disappointment that the Scottish

03:17Government did not announce that position before the health board statement. Every single

03:23one of us in the chamber—indeed, every single one of us across Scotland—has a right to

03:29hear first and directly from the services that care for us if our treatment for any

03:34health matter is going to change. That is why it was absolutely correct that, before

03:41making a public announcement, NHS Greater Glasgow and Clyde and NHS Lothian took time

03:46to speak to all the young people who would be impacted by the pause, so that they understood

03:52what that meant for their care and treatment.

03:55I am sure that everyone in the chamber will agree that, if that was happening to their

03:59loved one, that is exactly what they would want and expect to happen. I reiterate that

04:07those young people and their families must be at the heart of our decisions and thoughts

04:11when we discuss this issue.

04:13The NHS Greater Glasgow and Clyde young people's gender service in Scotland remains absolutely

04:19committed to providing the best quality care for patients and referrals. The service will

04:24continue to provide holistic care and support to those accessing and referring to it.

04:31The CAS review is a detailed, wide-ranging report, and I welcome the opportunity to update

04:36Parliament on our approach to the recommendations and wider work in this field. It is important

04:43to highlight that the CAS review was commissioned by NHS England and did not review clinical

04:48services or pathways that are provided in the NHS in Scotland. Therefore, by definition,

04:55clearly not all the recommendations may be applicable to NHS services in Scotland.

05:01That said, it is vitally important that the recommendations are carefully considered to

05:06assess to what extent they are relevant to the approach to gender identity healthcare

05:11in Scotland, and to decide on what steps may need to be taken as a result. Time is required

05:17to fully consider all the recommendations, which NHS England also acknowledges.

05:25We already have a strategic action framework for the improvement of NHS gender identity

05:31services. As part of that work, the chief medical officer has agreed that the deputy

05:36chief medical officer and other senior medical officers will support careful consideration

05:41of the CAS review's clinical recommendations and engage on those with the Scottish Association

05:47of Medical Directors and other clinical leaders. A multidisciplinary clinical team within the

05:53office of the chief medical officer in the Scottish Government, including paediatric,

05:58pharmacy and scientific expertise, will assess the clinical recommendations and engage with

06:04the relevant clinical community and leadership in health boards in relation to those recommendations.

06:10The CMO will provide a written update to Parliament on the outcome of that clinical

06:15consideration process before the summer recess. It is important to note that, in Scotland,

06:21we are already making progress in a number of aspects of gender identity healthcare that are

06:26highlighted in the CAS review. Let me be clear that work has already begun, and I will remain

06:33engaged throughout. For example, Dr Cass highlights the need to address increased capacity in services.

06:39The Scottish Government has committed to invest £9 million to support the improvement

06:44of NHS gender identity healthcare in Scotland. That funding will be delivered over a five-year

06:50period, so that national improvement work that is already under way will be embedded and built

06:55upon. That aligns with feedback that has been received from health boards and third sector

07:00stakeholders regarding the need to support longer-term sustainability of service improvement.

07:05Since December 2022, we have invested more than £2.8 million to support work to improve

07:11access to gender identity healthcare in Scotland, with more than £2.2 million of that

07:16allocated directly to health boards with gender identity clinics. We will invest a further £2

07:22million this year and a further £2 million in each of the next two years, and we are committed

07:27to long-term sustainable funding for those services beyond that point.

07:33We are also working with NHS Greater Glasgow and Clyde and NHS National Services Scotland

07:38to establish a nationally commissioned young people's gender service,

07:42part of ensuring that young people's gender care in Scotland is as person-centred

07:47and effective as possible. The Cass review recommends that gender identity healthcare

07:53must operate to the same standards as other clinical services. We agree. We have already

07:59commissioned Healthcare Improvement Scotland to develop new national standards for gender

08:03identity healthcare, and those standards are expected to be published this summer.

08:08A key focus throughout the review is the need for better, high-quality evidence in this field.

08:13We agree.

08:15Long before the publication of the report, we provided the University of Glasgow with

08:19grant funding to establish a programme of research into the long-term health outcomes

08:24of people accessing gender identity healthcare. That includes six projects, where the health

08:29outcomes of both adults and young people are considered, covering cardiovascular health,

08:34hypertension, sexual health, mental health and longer-term wellbeing. The outputs of those

08:40projects are expected towards the end of this year. In addition, the Scottish Government and

08:45Scottish health boards are observers to NHS England's planned study into the use of puberty

08:51blockers in young people's gender identity healthcare, and discussions are on-going to

08:56determine what further involvement is appropriate. It did not take the publication of the review

09:04for us to start a broad programme of work to improve gender identity healthcare.

09:09In addition to the work that I have already highlighted, we have commissioned Public

09:13Health Scotland to develop a quarterly aggregate data collection for NHS gender identity clinic

09:19waiting times, and we are supporting NHS National Education Scotland to develop new

09:24training materials for staff. Importantly, throughout that work, we have engaged with

09:30trans and non-binary people across Scotland who have lived experience of accessing or waiting

09:36to access gender identity services, to ensure that their voices are represented in our work

09:41to improve that care. Building on that, and in response to the understandable concern from those

09:47impacted by the change and, more broadly, the provision of gender identity healthcare to young

09:53people, we will hold a round table with stakeholders representing those affected.

09:58I will continue to engage directly with young people.

10:05I understand how difficult and heartbreaking the announcement last week will have been

10:10for the small number of young people and their families who were anticipating

10:14that they would soon be able to start those treatments. Dr Cass reminds us in her report

10:20that a compassionate and kind society remembers that there are real children,

10:26young people, families, carers and clinicians behind the headlines. I hope that that sentiment

10:34is one that we can all keep in mind today and as we move forward.

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