Chamber and committees

It is not really, because it was England that decided to do the Cass review, not us. The emerging evidence did not push us into asking whether we should pause, or have a think about where we are and launch such work. England did that and we have followed on the back of it. I do not necessarily think that what you say is exactly the case.

Thank you.

Good morning. I remind the committee of my entry in the register of members’ interests, which states that I am a practising NHS general practitioner.

Professor Smith, you have said today that we need more evidence in this area. You have also said:

“The Cass Review highlighted that the evidence for prescribing gonadotrophin releasing hormone (GnRH) analogue to suppress puberty is inadequate and the risk of short- or long-term harm remains uncertain.”

My question to you, therefore, is this. Why were we allowed to get in a position in which such medication was given to children, even though, according to your own words, the knowledge about it is uncertain and inadequate?

I want to ask two questions, if I may.

Building on Emma Harper’s questions, I note that Professor Ellis said that the MDT would include a psychiatrist. We know from comparative studies that transgender young people are about four times more likely to think about attempting suicide, and the latest stats show that, in 2023, more than 7,000 children and young people had their referrals rejected by CAMHS, which is an average of 26 children a day. How are you going to get psychiatry involved in this particular MDT if we cannot provide basic services to children around our country at the moment?

In the devolved health service, we are watching, but we did not do anything to start it off.

My final question is for Professor Strath. Will you please give us an update on where we are with current research and current indications on what is happening? I appreciate that it is always difficult to tell with trials, but roughly when will we get an update?

Professor Smith, hospitals are pushing more and more things to GPs—and I say that as a GP. The standards, as written, make it clear that gender services are able to push prescribing to GPs, too. Having spoken to many GPs, I know that they are very concerned, and a lot of them are not comfortable with prescribing puberty blockers, because, for example, they feel that such activity is off licence, they are awaiting robust evidence or they see that there is no formal protocol. Moreover, the Royal College of General Practitioners supports GPs not taking on shared care, there is the potential for litigation if patients decide that puberty blockers are harming them, one in two patients have, as Professor Ellis has told us, underlying mental health issues, and the General Medical Council has told us that prescribing must be appropriate.

If those issues are not addressed, are we following GMC competence? Can you reassure me that the prescribing of puberty blockers will not be pushed to primary care without GPs having the credentials—and, indeed, wanting—to take that work on, and that all GPs will be able to opt out?

Absolutely, and that is where we are right now, but my question goes back to when the services were set up, when things were beginning and money was being spent on creating a service. Explain to me what randomised controlled trial—for “quality” and “safety”, in your own words—said that the prescribing of GnRH to children was acceptable and safe in this case.

This will be my final question. On 27 September, the Scottish Government told the BBC that it was “extremely disappointing” that some COSLA leaders had chosen to “frustrate progress” towards a national care service. Do you feel that that is an accurate representation? Did you engage with the Government after the draft amendments were laid? If you did, what was the timeline of the response that you received?

I was part of a panel that talked about palliative care and some of the issues that surround it. Funding is one of the big challenges, as with most things. People perceive that there is a lack of funding for palliative care. People feel that there is also a huge and disproportionate difference between the palliative care that you will receive at the end of your life if you are from an ethnic minority or a more deprived background and the care that others receive. That inconsistency is not just present in one health board; it exists across our country. With no more money going into palliative care—that is not what the national care service is about—and given that huge discrepancy, what can the national care service do to make a tangible difference to the people who are most disproportionately affected?

I would like to examine how we can evaluate what is going on. Looking at the bill, I believe that there are no references to rights, accessibility, ethical commissioning, procurement or quality, and, as we have just heard, children’s services are currently in crisis. How are we supposed to evaluate what happens to people on the ground if the bill is brought in?