Chamber and committees

That is helpful—thank you.

I apologise for not asking Katie MacGregor whether she wanted to comment on that.

That is really helpful, thank you.

My question was about pay.

I will be quick, as we are almost out of time. I have questions on the national care service charter. Are there any thoughts on the charter and the co-design process—which is one thing that has been flagged up as a positive? If we are going to have a charter, should it be a living document that can include learning from experience of its working in practice?

I am also keen to hear any comments that folk have about a complaints process and what that might look like.

Katie, do you want to go first?

Can you just expand a bit on the differences between independent advocacy and independent advice? I think that it is a really important point.

On the BMA’s view about the process of a critical review, the ultimate test of the robustness of scientific research is normally a peer review process. Apart from the University of York, which I think was a partner rather than a peer reviewer, are you aware of that having happened before the publication of the Cass review? Normally, there would be a peer review before someone published a paper in, for example, Nature.

Do you have any thoughts on why there appears to be a difference in this case? As you have said, this evidence exists—it was produced by other people—and it has, in the Cass review, been distilled in a particular way and used in coming to the review’s conclusions. I have no medical training so I will not question that at all. However, it appears that people with similar qualifications and medical experience in other countries have come to very different conclusions. Do you have any thoughts on that? It is never black and white, is it?

That is really helpful.

You mentioned treatment, so I will home in on one area of treatment about which there is concern, namely, hormone treatments. Prior to the assessment of the Cass review, of the significant numbers of people who came for support, a relatively small number were receiving hormone treatment. That has been suspended.

What are your thoughts on what that means for those young people? I am aware of constituents who, even under the previous system, were accessing hormone treatment by legal private means, with all the risks that go with being unable to get support with on-going assessment of their hormone levels. What will be the implications of the current restriction for young people?

That is really helpful in distinguishing between puberty blockers and other hormonal treatments. Have other hormonal treatments been restricted as well?