Tories demand NHS answers over puberty blockers as SNP under pressure over Cass review

The Scottish Conservatives have demanded a ministerial statement from the Scottish Government on its course of action after a report by Dr Hilary Cass concluded the use of puberty blockers from the age of 16 in England should be done with “extreme caution”, warning that “we have no good evidence on the long-term outcomes of interventions to manage gender-related distress".

The document added: “There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18.”

The report said that the “current understanding of the long-term health impacts of hormone interventions is limited and needs to be better understood”.

Before the Cass review was published in full, NHS England had already confirmed children south of the Border will no longer be prescribed puberty blocker hormones at gender identity clinics routinely and only though clinical trials.

In its initial response to the Cass review, the Scottish Government said it will “take the time to consider the findings of the final report in the context of how such healthcare can be best delivered here in Scotland”.

NHS Scotland states that puberty blockers “are not available to children and young people for gender incongruence or gender dysphoria because there is not enough evidence of safety and clinical effectiveness”.

It adds that “from around the age of 16, young people with a diagnosis of gender incongruence or gender dysphoria who meet various clinical criteria may be given gender-affirming hormones alongside psychosocial and psychological support”.

Reports suggest there are fewer than 20 young people in Scotland being prescribed puberty blockers by NHS Scotland for gender dysphoria.

The Scottish Conservatives accused SNP ministers of failing to respond to the findings and have demanded answers from the head of NHS Scotland.

Scottish Tory deputy leader, Meghan Gallacher, said there needs to be an “urgent evaluation” of services in Scotland to “ensure the wellbeing of young people in Scotland isn’t going to be less protected”. The Conservative MSP made the plea in a letter to Caroline Lamb, the chief executive of NHS Scotland, after ministers rejected her appeal to make a statement on the issue to Holyrood.

With the report also stating there was “not enough evidence” puberty blockers are safe or effective, Ms Gallacher accused the Scottish Government of ignoring its findings.

While the Cass review was conducted into services in England and Wales and not north of the Border, the Conservative MSP insisted its findings were “just as relevant and important here in Scotland”.

Ms Gallacher said: “The Cass review concerningly found that children accessing gender services have been failed. This isn’t acceptable.

“The SNP have buried their heads in the sand and refused to pause puberty blockers. Now they have rejected my request for a ministerial statement on this report.

“The SNP government cannot ignore the significant recommendations made by the review.”

Ms Gallacher added: “Our priority must be ensuring the wellbeing and safeguarding of vulnerable young people.

“Parents and young people urgently need clarity regarding this sensitive topic. Children don’t need the government or health service sweeping this under the rug, they need answers.”

Since 2018, those waiting for a first appointment at one of Scotland’s five gender identity clinics has soared from less than 1,000 to more than 5,000. As of the end of 2023, Scotland's only specialist gender clinic for under-18s, at the Sandyford in Glasgow, had more than 1,100 patients on its waiting list.

In her letter to Ms Lamb, the Tory deputy leader called for a “serious and open discussion” about what happens next with services for the increasing number of children and young people who are “experiencing gender dysphoria or questioning their identity”.

Ms Gallacher said the “rapid increase” in young people questioning their gender had left the clinic “struggling to cope with the rising numbers”. She urged Ms Lamb to publish any evidence used by the NHS in Scotland to support the use of puberty suppressing hormones.

The gender debate, which Dr Cass acknowledged has been “toxic, ideological and polarised”, has become a huge political football in Scotland, particularly over the now-scrapped legislation for self-ID. The gender recognition reforms resulted in Ash Regan quit her junior government role in protest while the SNP faced its largest ever rebellion over the issue with nine MSPs refusing to vote in favour of the government position.

But those SNP backbenchers who rebelled against the gender recognition reforms are considering another backlash at Mr Yousaf’s leadership and government deal with the Greens.

Scottish Labour leader Anas Sarwar said "the Scottish Government has got to look at the recommendations” in the Cass review and “urgently come to parliament with what steps they’re going to take to reflect those recommendations”.Asked if Scotland should have its own Cass review, Mr Sarwar said: “Potentially - but for some of it we don’t need to reinvent the wheel.“There’s individual services to be looked at and we shouldn’t be afraid to do that.”

A Scottish Government spokesperson said: “The Scottish Government has regular engagement with NHS health boards, regarding work to improve gender identity healthcare, including care for young people.

“The Scottish Government has been clear that decisions on how healthcare is delivered in Scotland are best made by health boards and clinicians. We have also been clear that NHS health boards are thoroughly considering the evidence from the Cass review. If changes are made to pathways and services following consideration of new evidence it is right that any patients directly impacted by those changes should be the first to hear about them – sensitively and from the services caring for them.”

First Minister Humza Yousaf also faces a challenge to Scotland’s controversial new hate crime law in the Scottish Parliament this week.

The Tories will use their party business slot at Holyrood on Wednesday to debate the legislation and force a vote calling for it to be ditched.

It comes amid ongoing controversy over the Hate Crime and Public Order (Scotland) Act.

Police have been inundated with thousands of complaints since the law took effect on April 1, and there are concerns over its impact on freedom of expression.

Lord Hope of Craighead, one of Scotland’s most senior legal figures, previously condemned it as “unworkable”.

However, Mr Yousaf has strongly backed the law and accused some opponents of spreading “misinformation” about it.

Tory justice spokesman Russell Findlay said the legislation is placing an intolerable strain on Scotland’s overstretched police.

The SNP-Green majority at Holyrood means the motion to repeal the Hate Crime Act will almost certainly fall, but the Tories are appealing for other opposition parties and “more sensible nationalists” to back their position.

Mr Findlay said: “Humza Yousaf’s disastrous hate crime law has caused utter chaos in the fortnight since its introduction. It is proving every bit as unworkable as many critics warned – and must be repealed.”

A Scottish Government spokesman said: “The Hate Crime Act helps to tackle the harm caused by hatred and prejudice and provide greater protection for people in society and communities who face hatred just because of who they are.

“It does not prevent people expressing controversial, challenging or offensive views – nor does it seek to stifle criticism or rigorous debate in any way and the right to freedom of expression is built into the Act. Police Scotland has been clear that demand continues to be managed within its contact centres and the impact on frontline policing has been minimal