Chamber and committees

I thank the Conservatives for securing the debate and Dr Hilary Cass for giving evidence to the Health, Social Care and Sport Committee yesterday. However, one hour is not enough to fully engage with Dr Cass’s recommendations. Drastic change is urgently needed to safeguard Scottish children from what I believe is a medical scandal.

The Government must urgently understand the striking difference in patients who are presenting for gender identity services. It has changed from a few young boys to a large and rapidly increasing number of teenage girls, with complex presentation. Often, they are young lesbians or autistic girls, many of whom have serious mental health issues such as depression, anxiety and eating disorders, and who may be self-harming. Those issues are often caused by abuse or neglect. We must investigate the reason for the change in patient profile. Increasingly, girls are opting out of womanhood, and we cannot just shrug that off. We need to look at the issue and address it.

The treatment protocol for gender identity with affirmation and being funnelled towards a medical pathway overshadows the other problems that I have highlighted and neglects, to those girls’ detriment, alternative psychological treatment options. Clinicians tried to raise the alarm from the inside that those girls were being harmed by an approach that was developed for boys. From whistleblowers such as Dr David Bell and safeguarding lead Sonia Appleby, we know what happened to clinicians—they were ignored at best and silenced at worst. In the end, many of them left.

In Cass’s words,

“puberty blockers, cross-sex hormones and even surgery may be a suitable treatment for some. We just do not know which ones.”

Given the severe health risks of the treatment, we need a service model that considers the child’s right to an open future and offers appropriate therapeutic care to each patient.

Detransitioners say that many do not understand the risks of testosterone, such as fertility loss, vaginal atrophy, clitoral growth and pain affecting sexual function. Cass recommends that gender services should learn from and understand detransitioners. That is difficult to do when, understandably, many refuse to return to the service that has failed them.

We must ensure that legislation, education and health services are Cass compliant. The school guidance is inappropriate and should be withdrawn. Are we sending the message that homophobia is unacceptable and that loving acceptance of our body is important? The evidence would suggest otherwise.

The Cass report is a watershed moment. Vulnerable children are at its heart. The Government’s amendment shows that it does not understand the severity of the problem or the urgency that is required to fix it. What does the Government imagine that the outcome of a thorough examination of the most comprehensive, recent and meticulous review of the global body of research will be?

The Scottish Government can prevaricate to placate lobby groups, or it can remove its ideological blinkers and focus on the urgent clinical need to improve how we provide care to support distressed children. There is no excuse for any further delay. Maya Angelou famously said:

“Do the best you can until you know better. Then when you know better, do better.”

The minister has just set out that the CMO will seek to provide a written statement to the Parliament on the progress that is being made, but I ask the Government to consider that it might be advisable for the CMO to appear in Parliament to aid that scrutiny.

Thank you. I have a question on detransitioners, if I may.

Good morning, Dr Cass. I want to pick up on a couple of areas that have already been discussed. The first is about the cohort of patients. The data shows a huge and quick increase in birth-registered females, the majority of whom are same-sex attracted. That is a very different cohort from the one that was considered in the earlier studies. Also, the new cohort’s presentation is much more complex. You have suggested that care should routinely include, for instance, screening for neurodevelopmental conditions. Will you tell us a little bit more about the change in the cohort, the extent to which treatments had been based on the previous one, and the potential risks around that?

Having raised the need for urgent action, I welcome the news that Petroineos has invested in and restarted the hydrocracker and that the site is turning a profit. The save Grangemouth campaign, which is headed by my Westminster colleague Kenny MacAskill, aligns itself with the results of a recent survey by Unite the union, which strongly indicates that there has been a collective failure by both Governments to support Grangemouth. What substantive commitment will the Government now make to ensure a long-term sustainable future for this core asset for Scotland’s energy industry, so that there is no cliff edge for both workers and Scotland’s energy security?

To ask the Scottish Government whether it still plans to deliver the shared policy programme contained within the Bute house agreement, in light of reports that many of its policies have been discarded. (S6O-03371)

What is the point of the current First Minister dramatically chucking the Greens out of the front door only for the next one to sneak them in round the back?

Given the importance of this issue, the public would have rightly expected the First Minister or the Cabinet Secretary for NHS Recovery, Health and Social Care to have made the statement.

On 28 March, I asked the health secretary to pause the prescribing of puberty blockers in Scotland. Now, it seems that he was unaware that clinicians at the Sandyford clinic had made the decision to stop doing so in mid-March.

When will the Government schedule a full debate on the comprehensive findings of the Cass report and its many implications for health, education and law in Scotland? From listening to the minister today, it seems as though the Government has not read or absorbed Cass’s conclusions. Is the Government really saying that it does not accept the report’s recommendations in full?

Following medical evidence reviews, Denmark, Finland, Norway, Sweden, France and England now sharply restrict or prohibit the use of puberty blockers for gender dysphoria. There is weak to no proof that they help, but there is much evidence of serious side effects. Puberty blockers prevent bone density development, they render children infertile and they can cause damage to the heart and severe depression. Class action lawsuits involving thousands of patients who have been damaged by puberty blockers are now under way in the US courts. What will it take for this Government to step in and protect Scotland’s children from this unethical experiment?

To ask the Scottish Government how many children aged 16 and under have been prescribed puberty suppressing hormones through NHS Scotland since 2014. (S6O-03286)