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Public Health and Women's Health Minister Jenni Minto
The Scotsman
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23/04/2024
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
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00:00
The next item of business is a statement by Jenny Minto on gender identity healthcare
00:06
for young people. The Minister will take questions at the end of her statement, so there should
00:10
be no interruptions or interventions.
00:13
I call on Jenny Minto, Minister. Up to 10 minutes, please.
00:19
I want to start by speaking directly to our young people and, in particular, our trans
00:24
and non-binary young people across Scotland. I know that the past few weeks and months
00:30
have been incredibly difficult, with increased media attention and toxic online commentary.
00:36
I understand how shocking, upsetting and destabilising the announcements last week and the public
00:41
conversation around them will have been for you and your families.
00:46
I want to reassure you that the Scottish Government remains absolutely committed not just to ensuring
00:52
that on-going support is available for you, but to reforming and improving gender identity
00:57
healthcare. That was a key part of the Bute house agreement, and we will not waver in
01:03
that commitment.
01:05
Before I continue, I am clear that, as a Parliament, we have a responsibility to protect and support
01:11
minority groups. We are all human beings, we are all individuals and we all deserve
01:17
respect. It is vital that we lead by example and the tone of our discussions will be reflected
01:25
in this session.
01:28
Let me reiterate what the First Minister has clearly said. The cast review is a detailed
01:33
piece of work that requires thoughtful consideration.
01:38
Last Thursday, NHS Greater Glasgow and Clyde and NHS Lothian, the two health boards in
01:43
Scotland with specialist paediatric endocrinology services, issued a joint statement confirming
01:49
a pause on new prescriptions for puberty hormone suppressants and cross-sex hormone medication
01:55
for young people with gender dysphoria. That pause is to allow time for further evidence
02:01
to be gathered to support the safety and clinical effectiveness of those medications following
02:07
the cast review.
02:08
The statement also confirmed that the small number of young people who are currently receiving
02:13
those medicines will not be affected by that pause, mirroring the position in NHS England.
02:20
As I have said consistently, it is not for politicians or civil servants to make clinical
02:25
decisions about clinical pathways. Those decisions should always be made carefully, be based
02:32
on the best evidence available and be made only by clinicians who are responsible for
02:37
providing such healthcare. To be very clear, ministers do not make clinical decisions in
02:43
any field of medicine, and gender identity services are no exception. I fully support
02:49
health board autonomy in clinical decision making.
02:52
The commitment of clinicians to their patients in those services, alongside their wider multidisciplinary
02:58
teams, is unwavering. Their focus is always on ensuring that the treatment that they prescribe
03:04
is safe. Too often, they face vitriol simply for doing their job, and it is important that
03:10
they are supported, too.
03:13
I know that some members in the chamber have expressed disappointment that the Scottish
03:17
Government did not announce that position before the health board statement. Every single
03:23
one of us in the chamber—indeed, every single one of us across Scotland—has a right to
03:29
hear first and directly from the services that care for us if our treatment for any
03:34
health matter is going to change. That is why it was absolutely correct that, before
03:41
making a public announcement, NHS Greater Glasgow and Clyde and NHS Lothian took time
03:46
to speak to all the young people who would be impacted by the pause, so that they understood
03:52
what that meant for their care and treatment.
03:55
I am sure that everyone in the chamber will agree that, if that was happening to their
03:59
loved one, that is exactly what they would want and expect to happen. I reiterate that
04:07
those young people and their families must be at the heart of our decisions and thoughts
04:11
when we discuss this issue.
04:13
The NHS Greater Glasgow and Clyde young people's gender service in Scotland remains absolutely
04:19
committed to providing the best quality care for patients and referrals. The service will
04:24
continue to provide holistic care and support to those accessing and referring to it.
04:31
The CAS review is a detailed, wide-ranging report, and I welcome the opportunity to update
04:36
Parliament on our approach to the recommendations and wider work in this field. It is important
04:43
to highlight that the CAS review was commissioned by NHS England and did not review clinical
04:48
services or pathways that are provided in the NHS in Scotland. Therefore, by definition,
04:55
clearly not all the recommendations may be applicable to NHS services in Scotland.
05:01
That said, it is vitally important that the recommendations are carefully considered to
05:06
assess to what extent they are relevant to the approach to gender identity healthcare
05:11
in Scotland, and to decide on what steps may need to be taken as a result. Time is required
05:17
to fully consider all the recommendations, which NHS England also acknowledges.
05:25
We already have a strategic action framework for the improvement of NHS gender identity
05:31
services. As part of that work, the chief medical officer has agreed that the deputy
05:36
chief medical officer and other senior medical officers will support careful consideration
05:41
of the CAS review's clinical recommendations and engage on those with the Scottish Association
05:47
of Medical Directors and other clinical leaders. A multidisciplinary clinical team within the
05:53
office of the chief medical officer in the Scottish Government, including paediatric,
05:58
pharmacy and scientific expertise, will assess the clinical recommendations and engage with
06:04
the relevant clinical community and leadership in health boards in relation to those recommendations.
06:10
The CMO will provide a written update to Parliament on the outcome of that clinical
06:15
consideration process before the summer recess. It is important to note that, in Scotland,
06:21
we are already making progress in a number of aspects of gender identity healthcare that are
06:26
highlighted in the CAS review. Let me be clear that work has already begun, and I will remain
06:33
engaged throughout. For example, Dr Cass highlights the need to address increased capacity in services.
06:39
The Scottish Government has committed to invest £9 million to support the improvement
06:44
of NHS gender identity healthcare in Scotland. That funding will be delivered over a five-year
06:50
period, so that national improvement work that is already under way will be embedded and built
06:55
upon. That aligns with feedback that has been received from health boards and third sector
07:00
stakeholders regarding the need to support longer-term sustainability of service improvement.
07:05
Since December 2022, we have invested more than £2.8 million to support work to improve
07:11
access to gender identity healthcare in Scotland, with more than £2.2 million of that
07:16
allocated directly to health boards with gender identity clinics. We will invest a further £2
07:22
million this year and a further £2 million in each of the next two years, and we are committed
07:27
to long-term sustainable funding for those services beyond that point.
07:33
We are also working with NHS Greater Glasgow and Clyde and NHS National Services Scotland
07:38
to establish a nationally commissioned young people's gender service,
07:42
part of ensuring that young people's gender care in Scotland is as person-centred
07:47
and effective as possible. The Cass review recommends that gender identity healthcare
07:53
must operate to the same standards as other clinical services. We agree. We have already
07:59
commissioned Healthcare Improvement Scotland to develop new national standards for gender
08:03
identity healthcare, and those standards are expected to be published this summer.
08:08
A key focus throughout the review is the need for better, high-quality evidence in this field.
08:13
We agree.
08:15
Long before the publication of the report, we provided the University of Glasgow with
08:19
grant funding to establish a programme of research into the long-term health outcomes
08:24
of people accessing gender identity healthcare. That includes six projects, where the health
08:29
outcomes of both adults and young people are considered, covering cardiovascular health,
08:34
hypertension, sexual health, mental health and longer-term wellbeing. The outputs of those
08:40
projects are expected towards the end of this year. In addition, the Scottish Government and
08:45
Scottish health boards are observers to NHS England's planned study into the use of puberty
08:51
blockers in young people's gender identity healthcare, and discussions are on-going to
08:56
determine what further involvement is appropriate. It did not take the publication of the review
09:04
for us to start a broad programme of work to improve gender identity healthcare.
09:09
In addition to the work that I have already highlighted, we have commissioned Public
09:13
Health Scotland to develop a quarterly aggregate data collection for NHS gender identity clinic
09:19
waiting times, and we are supporting NHS National Education Scotland to develop new
09:24
training materials for staff. Importantly, throughout that work, we have engaged with
09:30
trans and non-binary people across Scotland who have lived experience of accessing or waiting
09:36
to access gender identity services, to ensure that their voices are represented in our work
09:41
to improve that care. Building on that, and in response to the understandable concern from those
09:47
impacted by the change and, more broadly, the provision of gender identity healthcare to young
09:53
people, we will hold a round table with stakeholders representing those affected.
09:58
I will continue to engage directly with young people.
10:05
I understand how difficult and heartbreaking the announcement last week will have been
10:10
for the small number of young people and their families who were anticipating
10:14
that they would soon be able to start those treatments. Dr Cass reminds us in her report
10:20
that a compassionate and kind society remembers that there are real children,
10:26
young people, families, carers and clinicians behind the headlines. I hope that that sentiment
10:34
is one that we can all keep in mind today and as we move forward.
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