Chamber and committees

It is undeniable that homophobia and transphobia are on the rise, and that is absolutely true when it comes to the weaponisation of the Cass review. The debate today is premature at best. It is absolutely right that the Government takes its time to assess the implications of the report, if there are any, for the Scottish NHS. [Interruption.]

Yes—absolutely. The other thing that was highlighted at committee was the on-going distress and mental health issues for those young people who experience long waits.

From listening to the debate so far, many could believe that people’s experience of gender identity services is overwhelmingly negative. For some, their most negative experience is to do with waiting times and not getting the care that they should receive. Although many have said that receiving the gender-affirming care that they needed was life saving and that it brought joy and allowed them to be their true selves, that does not mean that services do not need to be improved.

In addition to waiting times, clinicians’ confidence in providing care is a very current and live issue. In the briefing that Scottish Trans provided ahead of the debate, it notes that, at the moment, far too few healthcare practitioners feel confident about supporting children and young people who are exploring or feeling distressed about their gender identity. Scottish Trans frequently hears from young people who seek support for non-gender-related distress such as depression or anxiety, who are referred on to specialist gender identity services if they also disclose that they are feeling uncertain about their gender identity or that they are trans. That means that they are put on extremely long waiting lists, sometimes for years, and they receive no support in the meantime, which is totally unacceptable. It is vital that, in general, children and young people’s mental health services and wider health services are able to provide support to all young people who fall within their area of expertise. That clearly highlights the need for more training.

One of the commitments in the Scottish strategic action framework for the improvement of gender identity services is the development of a transgender care knowledge and skills framework, which could result in the upskilling of healthcare practitioners across the NHS on the provision of care for trans people. I would be grateful if the minister could provide an update on work on that when she sums up.

I remain concerned about what the on-going debate here and on social media is doing for those young people who are only trying to access the care that they need and who have been thrust into an increasingly heated and partisan political storm. That very small group of young people need our support, not our judgment.

I will.

We have to be aware that the Cass review was a review of services and treatment pathways in NHS England that differ from those in Scotland. As many members have said in the chamber previously, not all the recommendations will be applicable to Scotland and some might be irrelevant, given that the analysis was of a different health service. That is why I believe that the debate is premature at best. For those recommendations that might be relevant, there are choices to be made about whether they require action. Any changes that are made should also include input from trans young people who have been through the service, those who are on waiting lists and their families.

Many have hailed the report as the end of gender-affirming care, but Dr Cass confirmed at the Health, Social Care and Sport Committee yesterday that puberty blockers and hormones are the correct way forward for some children and young people who are seeking gender identity care. It is important that, in providing gender-affirming care, we are clear that medical transition might not be the correct course of action for everyone and that timeframes for transition differ between people. We absolutely have to ensure that services are improved, both in terms of the pathways and the current models of care, and by tackling long waits.

Thank you. I have a final question. You have mentioned research in your other answers. What, in your view, does good research look like in this area, and do you think that it is important that trans and non-binary people are involved in all stages in co-producing it?

I think that Emma has covered most of what I was going to ask. Given the sort of issues that we have just covered around nutrients and reducing recommended amounts of meat by 20g or other amounts, and that a lot of evidence is coming out about how diet could change with climate recommendations and so on, how does Food Standards Scotland approach communication around some of that? There is the “Eatwell Guide”, but there is no guarantee that some of the evidence that comes out over the next period will not impact some of its recommendations.

The matter is quite nuanced. It might be for higher consumers, rather than for everybody, to reduce. There are potential knock-on impacts for groups that could be more affected by some of those changes than others, such as those in the lower ranges of meat consumption—there is a lot in that question, too. How do we approach that information environment as a whole? How do we ensure that we take in some of those underrepresented and potentially vulnerable groups in doing all of that?

Good morning, Dr Cass. Do you believe, and does your research show, that puberty blockers or gender-affirming hormones could be the right intervention for some children or young people?

A range of trans organisations and people have said that the report’s recommendations and the narrative surrounding it give the impression that transition would be the worst outcome for a young person. How would you respond to people who get that impression from the report?

Absolutely. I reassure Mr Doris that the number of sites that are currently protected represents those that are designated under the Abortion Act 1967. Any other premises covered by the bill as it stands would have to be designated under that act as providing such services. That would stop what has been called mission creep. I will be happy to have a wider discussion about that with Mr Doris after stage 1.

The final point that I must address is the recommendation that the default radius of the zone around protected premises should be reduced from 200m to 150m. I will happily discuss my position with all interested members over the coming weeks and at committee at stage 2. However, I must and will resist such a change.

The stage 1 report refers to scoping work showing that 150m suffices for all but one set of premises. We identified that we needed to address premises and factors that could provide a captive audience, such as bus stops and places where people come in and out of services and sites. We needed to ensure that the zone was big enough to capture all those places.

I realise that I might have to come to an end there, Presiding Officer, but I hope to be able to cover my remaining points at the end of the debate. I will be happy to speak to any members ahead of stage 2. I commend the bill to Parliament.

I move,

That the Parliament agrees to the general principles of the Abortion Services (Safe Access Zones) (Scotland) Bill.

Will Rona Mackay reflect on the fact that, because of how healthcare is delivered in Scotland, a whole load more services are affected by protests in Scotland than in England, Wales and Northern Ireland, because of the campus nature of our hospital sites? For example, some of the protests can be heard in the neonatal intensive care unit at the Queen Elizabeth hospital, so the impacts on healthcare as a whole are much wider.