I am today updating the House on the Government’s efforts to provide better outcomes for children and young people with gender incongruence, in line with the recommendations of the Cass review.
Children’s healthcare must always be led by evidence, and medicines prescribed to young people should be proven to be safe and effective.
The Cass review was clear that there is not enough evidence about the long-term effects of using puberty-suppressing hormones to treat gender incongruence to know whether they are safe or beneficial. It is a scandal that medicine was given to vulnerable young children without proof that it was safe or effective, and outside the rigorous safeguards of a clinical trial.
The review recommended that a clinical trial be commissioned within a full programme of research, which is being taken forward. This is the safest and most effective way of building an evidence base and charting a course through this challenging issue, where there are understandable concerns around safety, efficacy and consent. The Commission on Human Medicines —a statutory, expert body made up of clinicians and academics that provides independent advice to Ministers on the safety, efficacy and quality of medicines—considered information on the proposed trial and made recommendations, which have been adopted
On Saturday, following the receipt of full ethical approvals from the Medicines and Healthcare products Regulatory Agency and the Health Research Authority, King’s College London launched two new studies funded by NHS England to provide better evidence for how the NHS can support and treat young people with gender incongruence.
This includes the pathways trial—a carefully designed, randomised controlled clinical trial of puberty suppressing hormones for gender incongruence. This trial will involve young people being treated in NHS children and young people’s gender services with a formal diagnosis of gender incongruence. It will measure the impacts of these hormones on their cognitive, physical, social and emotional wellbeing. For their own wellbeing, there are strict eligibility criteria in place, including clinical review and parental consent. Young people will undergo comprehensive physical and mental health checks before and during the study, and will continue to receive psychosocial and other non-medical care while participating. If a young person meets the eligibility criteria, they will then be offered the opportunity to participate in the trial. The study team are now working to open sites for recruitment.
The trial has received comprehensive scientific, ethical and regulatory approval from the MHRA and from the Health Research Authority, including review by an independent research ethics committee. It follows the initiation of the observational pathways horizon study, and has been approved alongside the pathways connect study. The health and wellbeing of the children involved will always be our primary consideration.
NHS England has significantly increased both capacity and investment since April last year, with the opening of three new children and young people’s gender services in London, the north-west and the south-west. I am pleased to say a fourth service will open in the new year, with the ambition of service provision in every region of England by 2026-27.
Last year, NHS England reformed the referral pathway in these services. A referral can only be made by an NHS-commissioned, secondary care level paediatric service or a children and young people’s mental health service. This will ensure that healthcare professionals with the relevant expertise conduct the assessment and help to determine any co-existing mental health or other health needs of these children and their onward care.
I am determined to improve the quality of, and access to, care for all trans people. The full implementation of the Cass review will deliver material improvements in the wellbeing, safety and dignity of trans people of all ages. I will continue to work to help trans people to live freely, equally, and with the dignity that everyone in our country deserves.
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