NHS Adult Gender Identity Clinics

Question

Asked by

To ask His Majesty’s Government how many patients under the age of 25 have been referred to NHS adult gender identity clinics in each of the last three years; and what safeguarding measures are in place for those individuals.

My Lords, 5,624 patients under 25 were referred to adult gender dysphoria clinics in 2023-24, 6,355 were referred in 2024-25 and initial figures show that 6,167 were referred in 2025-26. There are strong safeguards within the existing service provision and specification that was agreed following public consultation, including with the medical royal colleges. These include specialist assessment, accounting for complex co-morbidities and care delivered by a multidisciplinary team with a wide range of expertise, including in neurodiversity and endocrinology.

I thank the Minister for that Answer, but I wonder if she has had a chance to review the landmark study from Finland recently, which suggests very strongly that gender medicine actually has a very negative impact on vulnerable young people with complex needs and, far from actually helping them, in fact is harming them. Can I urge her to expedite one of the most important recommendations from the Cass Review, which is to bring in a separate set of services for 17 to 25 year-old young people who are experiencing gender dysphoria? She will know that, currently, the adult clinics operate an affirmative model; that can be very worrying because young people can access life-altering and irreversible hormones after only two appointments. For young people with a whole set of complex needs, I do not think that is right.

My Lords, we are indeed committed to developing services for 17 to 25 year-olds, and I certainly recognise that this is a potentially very vulnerable time in a young person’s journey, as was clearly outlined in the report by the noble Baroness, Lady Cass. I can say to the noble Baroness that we recognise changing patient demographics, and therefore a holistic biopsychosocial assessment framework is being developed for use across all services, including a complexity measure to support understanding of the impact of any co-occurring conditions, as the noble Baroness refers to.

My Lords, we know that the 18 to 25 year-olds have many of the same complex problems as the under-18s and, as the Minister has said, they need similar holistic wraparound care, although that is not necessarily yet in place. However, Dr Levy’s review had a narrower remit than mine, focused on quality improvement rather than the model of care, so as a next step would the Minister agree to ask departmental and NHSE colleagues to convene a group, which should include independent experts, representatives of professional groups and representatives of the new children’s and young people’s services as well as service users, to consider how we best understand and, importantly, improve clinical outcomes for this group of young adults?

My Lords, I remain grateful to the noble Baroness for her work and her expertise in this area, which I know has been acknowledged both by the previous Government and this Government. I will certainly take on board what she has said and ask my officials to discuss this further with NHS England.

My Lords, I would like to seek some clarification from my noble friend the Minister about this matter, because the Mental Capacity Act 2005 presumes adult capacity and the Care Act 2014 defines safeguarding thresholds, which my noble friend has outlined in some detail already. Can my noble friend the Minister confirm that adults aged 18 to 25 referred to gender identity clinics are treated as autonomous patients without additional safeguarding measures beyond those which she has already outlined and apply to any competent adult?

Yes, I can assure my noble friend that patients are treated as individuals and their care is personalised. It is important, as my noble friend says, to recognise that the law presumes that patients aged 16 and over have capacity to consent to medical treatment. I can also give the reassurance, acknowledging as I have already that patients may have co-existing conditions that warrant additional safeguarding measures, that this will be determined on a case-by-case basis.

My Lords, if the Government are concerned with safeguarding those aged 18 to 25, can the Minister set out what assessment has been made of the documented harms caused by multi-year waiting lists, including serious impacts on mental health, physical well-being and life outcomes? Given the evidence that regret or detransition among those accessing gender-affirming care is rare, can the Minister clarify what specific risk this proposed safeguarding framework is intended to address?

It might be helpful if I speak in general terms. The Levy review highlighted multi-year waits for adult gender clinics. We recognise that waiting times are too long, and that is why we have increased the number of adult gender services from seven to 12 and we will be establishing a national waiting list. Dr Levy’s report did not make specific reference to concerns about safeguarding, and it is important to see it in that context. I emphasise once again that, where there are additional safeguarding matters, they will be dealt with on an individual basis as is right and proper.

My Lords, this is a highly sensitive topic, and I think we have to be very careful about how we talk about it. Evidence published in the BMJ shows a fiftyfold increase in recorded cases of gender dysphoria among children and young people between 2011 and 2021. While we should show compassion and not generalise about individuals presenting with gender dysphoria, what assessment has the Minister’s department made of the drivers for this rise in presentations? It is a sensitive issue, as I said, but are the Government assured that there are sufficient safeguards in place to ensure that the most vulnerable young adults are not irreversibly medicalised, only for some, even if just a small number, to regret it later?

The noble Lord makes a number of points. Let me be quite clear that surgical interventions are only for adults—that is for those aged 18 and over. As I said in my answer to the noble Baroness, Lady Maclean, I also refer to the fact that the strong safeguards in place include, among a whole range of others, specialist assessment, access to a multidisciplinary team and assessment of capacity. These are strong safeguards, and it is right that this is the case in order to support patients to get the care that is appropriate to them and which they need.

My Lords, NHS England’s Levy review catalogued failings in relation to a lack of data and tracking outcomes from gender dysphoria clinics. Can the Minister explain how the NHS can offer any treatment without such evidence relating to efficacy, benefits, harms, regret and detransition? Can the Minister also comment on the criticism that clinicians are reluctant to correct patients’ unrealistic expectations, often those of young women, about medical transition. They believe that hormones and surgery can change biological sex; they cannot. That is a scientific fact and surely NHS doctors should explain that.

I am not quite clear about the questions I am being asked. However, I return to the point about safeguards and say to your Lordships’ House that I have already outlined the strong safeguards, the professionalism and the medically informed evidence. Contrary to what is being suggested, there is no casualisation at all about decision-making.