Chamber and committees

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.

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.

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?

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?

I am delighted to open the stage 1 debate on the general principles of the Abortion Services (Safe Access Zones) (Scotland) Bill. I thank the Health, Social Care and Sport Committee for its scrutiny of the bill over the past few months.

I am also grateful to everyone who gave evidence. I know from recent experience that appearing before a committee can be daunting, so I appreciate everyone who did so, no matter their perspective. Given the significant issues that the bill raises, it is right that scrutiny should be robust and challenging, and the stage 1 report shows that it has been both those things. That makes me even more pleased that the committee has endorsed the bill’s general principles.

I also thank all the campaigners, including Back Off Scotland, Abortion Rights Scotland, individuals and clinicians for their work, support and campaigning. Undoubtedly, we would not be here without them all. Many of those who have campaigned for the bill are with us in the public gallery today.

First, I will provide some general comments on the bill. It is relatively small, but its size does not reflect the depth of feeling that it has provoked or the scale of change that it will bring.

There are three reasons for that. The first is simply that abortion can be deeply polarising. I do not expect or intend to change that. Even across the Parliament, we will hold different views.

However, the bill is not about the rights or wrongs of abortion; it is about the right and ability of patients to access care without running a gauntlet of disapproval and judgment. That relates directly to the second reason for opposition. Some do not think that there is a need for safe access zones. As I recently told the Health, Social Care and Sport Committee, I whole-heartedly wish that was so, but too many have given testimony that indicates otherwise. I will share a couple of examples.

From a woman responding to my consultation, there was this harrowing account:

“When walking into the clinic, I had two large older men screaming at me, calling me names. I had no one with me and no one to defend me when I was in no fit mental state to defend myself.”

She went on to say:

“Because of their cruel words during such a horrific and vulnerable time in my life, I carried that guilt for years.”

Professor Sharon Cameron, who gave evidence to the committee, said that

“Women attending the clinics have clearly been distressed, while others have been phoning up in advance of a consultation, anxious about entering the building and worried about protesters and perhaps media”,

that

“Feedback that we got at the time was that they were feeling targeted, anxious and harassed”

and that staff

“are also anxious and concerned about patients being put off attending our services, and the situation has resulted in additional workload”.—[Official Report, Health, Social Care and Sport Committee, 5 March 2024; c 2, 3.]

I urge anyone who doubts the bill’s necessity to reflect on those testimonies.

Attending any unfamiliar medical procedure can be stressful. Most of us worry about whether it will hurt or whether something will go wrong. Does anyone here not think that it would be more stressful—more frightening, even—if they also had to worry that there might be people waiting outside to convince them not to go in, perhaps to call them names or to inaccurately suggest that there might be consequences of that procedure that they had not thought of, such as cancer or infertility? All that the bill does is try to prevent that for women who are seeking an abortion to ensure that they have the same dignity and privacy that they would have for every other medical procedure.

That does not mean that members should stop asking tough questions about the bill, but I ask that members take the opportunity to protect women at a time when many are already incredibly vulnerable and all are, at the very least, making an enormously personal decision that should not be subject to unwanted comment from strangers.

That leads me to the third reason for opposition. The bill raises issues about freedom of expression, religion and assembly. There are those who agree with the bill in principle but who are concerned on those grounds. I have never taken those concerns lightly, and I would never stand behind a bill that threatened those fundamental rights. However, I am confident that the bill is a proportionate means of protecting women and staff from activities that—as members have heard—can have profound consequences.

However, the chamber need not rely only on my judgment. The stage 1 report says:

“the Committee has concluded that the restrictions the Bill imposes on those human rights as set out in Articles 8, 9, 10 and 11 of the ECHR are proportionate to its aims, namely strengthening the ability of women seeking an abortion to exercise their own rights under Article 8.”

I remain willing to discuss concerns at more length with any member, but I assure the chamber that the committee did not take those questions lightly either. That is evident, given the recommendations in the report, some of which I will now turn to.

I will come to some of the things that Mr Cole-Hamilton and I discussed shortly.

As, I hope, the chamber will understand, much of the report’s detail is still being worked through. However, I will provide what assurance I can today.

First, I note the repeated call for a post-legislative review. As a sitting member of the Parliament, I would always expect legislation to be reviewed, which is why I followed general precedent and did not explicitly provide for that. However, I recognise the particular concerns and the difficult balancing that is required in relation to the bill, and I am content to lodge an amendment at stage 2 to provide for a review.

Similarly, I note the concerns about reduction and extension powers, and specifically the recommendation that consultation should be required in the bill. I judged that consultation would occur as standard practice and that it was unnecessary to specify it. However, again in recognition of the issues at play, I will lodge an amendment to put that matter beyond doubt.

There are other recommendations on extension and reduction, as well as on parliamentary scrutiny more generally. Those are complex and important issues, and I am keen to give them the due consideration that they deserve. I will not commit to concrete actions today while that consideration is under way, but I commit to continuing to listen to concerns from members around the chamber and to alleviating as many of them as I can. That is true for the whole report.