Gender Identity Healthcare for Young People - Update and New National Standards

Presiding Officer, I am pleased to have the opportunity to provide a further update in person to parliament on this work.

I would like to start by speaking directly to trans and non-binary young people in Scotland. I know waiting times to access the specialist services which provide support for gender dysphoria, alongside the ongoing changes to how these services are provided, are worrying for you and your families. I have heard this directly from you in the meetings we’ve had, and I’ve read it in the correspondence which I’ve received from you and those that love you.

I also know that high levels of ongoing speculation and interest in these services along with accompanying and often toxic commentary whether online, in print or in person, can magnify your worry.

I hope this will be borne in mind by those who wish to comment on this sensitive subject.

And to those in the chamber today, it is vital that we lead by example in the tone of our discussions, not just today, but in all our words and work.

It is clear from colleagues’ correspondence to me, that I am not the only one hearing directly from, and listening to, young people and their families. Therefore, I am sure we all agree that they must be our priority and at the heart of all our discussions about how gender identity healthcare is provided and that everyone should be treated with respect.

Presiding Officer, in my parliamentary statement in April, I advised that a senior multi-disciplinary team in the Office of the Chief Medical Officer would consider the recommendations of the NHS England commissioned Cass Review and engage with relevant Health Boards.  And that I would provide an update to Parliament.

As a result of that work the Cass Review: Implications for Scotland Findings Report was delivered to Parliament on 5 July, the earliest opportunity following the pre-election period.

This Report is an important milestone in how we work together to deliver better gender identity healthcare for young people in Scotland.

The Scottish Government has accepted the findings of the Report in full and work has started to implement its recommendations.

One such recommendation is that gender identity healthcare services for young people are, and I quote:

“not provided in an adult sexual health setting (such as the Sandyford Clinic) but are provided within paediatric clinical settings, as with other age-appropriate services for children and young people.”

The Report also found that to ensure sustainable services a distributed network, or regional model, would be the appropriate delivery model instead of one site.

We are actioning this at pace to address the immediate fragility of gender identity healthcare for young people and to develop a sustainable longer-term model. We will use the Scottish Government’s new planning and commissioning approach to fragile services and are convening a senior ‘Task and Finish’ group to take this forward. This work will be overseen by the Chief Operating Officer’s Directorate within Scottish Government.

Other recommendations from the Report have already been implemented by NHS Scotland. For example, access to under 18s gender identity healthcare is now only through referral from a clinician.  This is in line with other child or adolescent specialist services and will help ensure any other health needs can be identified and addressed.

In a Progress Report I have published today, there is further detail on the actions taken and progress made so far. This includes the challenges around recruitment and retention of staff in these services; but also the next steps for their commissioning and provision, which will of course include the voices of service users.

Presiding Officer, the CMO Report and the Cass Review underlined the importance of research and data.

As I outlined in April, the Scottish Government commissioned Public Health Scotland in 2022 to develop a national dataset for NHS gender identity clinics. The first annual data set for both adult and young people’ services will be published this autumn.

The Parliament is aware we have already provided the University of Glasgow with grant funding, to establish a programme of research into the long-term health outcomes of people accessing gender identity healthcare. The first outputs of these projects are expected towards the end of this year.

Furthermore, in August the Chief Scientist for Health for the Scottish Government has confirmed to their counterpart in the UK Department of Health and Social Care the willingness of an NHS Scotland team - which will include the Scottish Government, NHS Greater Glasgow and Clyde and the University of Glasgow - to join the National Institute for Health and Care Research UK wide study on puberty suppressing hormones as a treatment option for gender dysphoria.

The CMO Report also highlighted the need for national standards as well as guidance on training and development for staff.

I am pleased that today Healthcare Improvement Scotland has published their National Standards for Gender Identity healthcare: Adults and Young People.

These have been developed following an extensive public consultation, as well as targeted consultation with people with lived experience, clinicians and a wide range of professional bodies. They will support clinical services and Health Boards to deliver positive changes in partnership with people using the services.

NHS Education for Scotland’s Transgender Care Knowledge and Skills Framework has also been published today. It sets out what NHS staff need to know about to care for trans and non-binary people and to improve training in this area. This Framework has also been created following consultation and engagement.

Further development of this framework focussing on staff working with children and young people has started and is expected to be completed in 2025.

Presiding Officer, I have been clear that to get this right, engagement with those involved in services whether a user or clinician is vital. Throughout this process the NHS has engaged constructively with people with lived experience to ensure their voices are represented.

And I have regularly and proactively done the same. As well as regularly meeting with young people since becoming a Minister last year, later this month I will meet a wide range of stakeholders representing those impacted by ongoing efforts within NHS Scotland to embed better service delivery and ultimately reduce waiting times.

I know colleagues across this chamber are doing the same, actively engaged with young people on this topic and committed to making sure their voices are heard.

Presiding Officer, I want to reiterate Scottish Government’s wider commitment to improve gender identity healthcare in Scotland for young people and adults.

Since December 2022 the Scottish Government has invested over £4.4 million to support gender identity healthcare improvement. Over £3.6 million of this is being allocated directly to NHS Boards providing gender identity clinics, to support them to improve service delivery.

Independent evaluation of the impact of that investment on waiting times and quality of care is underway. A report will be published this winter and its findings used to support future improvements.

We all want to see improvement in waiting times to access these services. I hope the breadth of work underway and published today illustrates our commitment to improve clinical services and support to the young people who need to access them and shows that much has been advanced since my last update to this Chamber.

The Cass Review and the CMO Implications for Scotland Findings Report both recognise that the wider societal discussion about gender identity is complex.

They recognise too that the significant public, media, and political interest in gender identity healthcare provision for young people may detract from the primary issue of providing the best clinical care necessary for them.

This underlines the need for the development of young people’s services to, and I quote from the CMO's Report, “take place with children, young people and their families in an active process of co-production.”

We all have a responsibility to make sure that children and young people grow up safe, respected and supported.

I hope that sentiment is one we can all keep in mind, today, and in the future.