Mr Andrew Selous (South West Bedfordshire, Conservative)

I beg to move amendment No. 40, in

schedule 1, page 14, leave out lines 11 and 12 and insert—

'(b) are registered medical practitioners recognised as currently practising in the field of gender dysphoria in the United Kingdom, and registered medical practitioners who have entries in the specialist register held by the General Medical Council which confers their eligibility to practise as consultant psychiatrists within the National Health Service (''medical members'').'.

Mrs Marion Roe (Broxbourne, Conservative)

With this it will be convenient to discuss the following:

Amendment No. 41, in

schedule 1, page 15, leave out line 7 and insert—

'(b) at least two medical members including—

(i) a registered medical practitioner recognised as currently practising in the field of gender dysphoria in the United Kingdom, and

(ii) a registered medical practitioner who has an entry in the specialist register held by the General Medical Council which confers their eligibility to practise as a consultant psychiatrist within the National Health Service.'.

Amendment No. 34, in

clause 3, page 2, leave out lines 16 to 21 and insert—

'(a) a report made by a registered medical practitioner recognised as currently practising in the field of gender dysphoria in the United Kingdom, and

(b) a report by a registered medical practitioner who has an entry in the specialist register held by the General Medical Council which confers their eligibility to practise as a consultant psychiatrist within the National Health Service.'.

Amendment No. 35, in

clause 3, page 2, leave out lines 24 to 27 and insert—

'(a) a registered medical practitioner recognised as currently practising in the field of gender dysphoria in the United Kingdom, and

(b) a registered medical practitioner who has an entry in the specialist register held by the General Medical Council which confers their eligibility to practise as a consultant psychiatrist within the National Health Service, includes details and justification of the diagnosis of the applicant's gender dysphoria.'.

Amendment No. 36, in

clause 27, page 12, leave out lines 15 to 17 and insert—

'(a) a report made by a registered medical practitioner recognised as currently practising in the field of gender dysphoria in the United Kingdom, and

(b) a report by a registered medical practitioner who has an entry in the specialist register held by the General Medical Council which confers their eligibility to practise as a consultant psychiatrist within the National Health Service.'.

Amendment No. 37, in

clause 27, page 12, line 20, leave out paragraph (a) and insert—

'(a) the reference in subsection (1) to a registered medical practitioner is to one recognised as currently practising in the field of gender dysphoria in the United Kingdom.'.

Mr Andrew Selous (South West Bedfordshire, Conservative)

Amendments Nos. 40 and 41 relate to the list of people eligible to sit on gender recognition panels, and amendments Nos. 34 to 37 relate to the authority of the evidence submitted to the gender recognition panels.

A number of Members have talked about a rigorous assessment in relation to the process of gender recognition. The amendments would ensure that a proper and rigorous assessment was carried out, in terms of those on the panel and in terms of the evidence provided. There should not be disagreement across the Committee on this. I note that in the other place Lord Filkin said that he believes that excellent diagnostic decisions are vital in these matters. I hope that the amendments go some way towards providing such decisions. They are intended to ensure that there is a high level of medical scrutiny, that the quality and independence of the panel are beyond question, and that it is not just a rubber-stamping exercise—that phrase was referred to earlier.

Most commentators would agree that gender dysphoria is a psychiatric condition, and therefore it seems sensible that one of the members of the panel should be a competent psychiatrist. That is not currently a requirement. The Government seem happy with chartered psychologists giving evidence. I understand that that can mean more or less anyone registered as a psychologist. The amendments suggest that there should be a properly qualified psychiatrist on the panel. There are thousands of qualified consultant psychiatrists in the UK who would be available to sit as members of gender recognition panels. The amendments also propose that the panel should consist of at least three members, in addition to the president, two of whom should be medical members, one of whom is a recognised psychiatrist.

All the amendments follow the grain of the discussion that we have had so far this morning about the process being rigorous and not a rubber-stamping exercise. They accord with comments made by Lord Filkin in the other place when he said that excellent diagnostic decisions are vital. I hope that the Minister will look favourably on the amendments.

Mr David Lammy (Parliamentary Under-Secretary, Department for Constitutional Affairs; Tottenham, Labour)

The amendments would make the application process more onerous. They would add unnecessary burdens to a robust and credible process. The first amendments in the group, amendments Nos. 34 and 35, would mean that there had to be two diagnoses of gender dysphoria: one from a registered medical practitioner working in the field of gender dysphoria; the other from a consultant psychiatrist. It is sought not only to double the evidential burden on the applicant, but to limit those experts from whom

evidence is accepted. That would ensure that the evidence of a chartered psychologist working in the field of gender dysphoria would not be accepted. The Bill seeks to establish a robust and credible process by which transsexual people are to seek recognition in their acquired gender. We do not believe that the amendments would add to that objective.

It is important to emphasise that a typical treatment path will oblige the applicant to undergo a series of assessments. As I explained, that assessment and transition process is long, arduous, wholeheartedly invasive and taken extremely seriously by the medical profession. I emphasise also that the Government's guidance on the diagnosis and existence of gender dysphoria is taken from the chief medical officer. He explains that, partly because of the number of people involved, the institutions and hospitals that conduct such assistance are not numerous. Their number is so small that I can list them all: Leeds, London—services are provided jointly by Ealing, Hammersmith and Fulham mental health trusts; in Hammersmith at the Charing Cross hospital—Newcastle, Nottingham, and Sheffield. Those institutions, which involve a number of specialists in assisting a transsexual person to complete their assessments and transition, are reflected in how we have set about establishing the evidence based in the Bill.

The first requirement of an applicant for recognition is the diagnosis of gender dysphoria. According to the Bill, that diagnosis must be provided by a medical practitioner or by a chartered psychologist practising in the field of gender dysphoria. The diagnosis of a specialist is essential because a specialist will know the diagnosis criteria well, apply recognised standards of care and have experience of dealing with a range of patients—those who are certainly gender dysphoric, those who are borderline and those who are not gender dysphoric. The hon. Member for South-West Bedfordshire should bear in mind that we are talking about a small pool of specialists whose work and assessments we expect the panel to come to know well. They know full well about the provisions in the Bill and the standards that are required.

A person working in the field of gender dysphoria will have as a precondition for an application to succeed to make the critical judgment about whether a person has gender dysphoria. The amendments would require two diagnoses of gender dysphoria: one from a registered medical practitioner working in the field and one from a consultant psychiatrist.

Some people will no doubt have two independent medical reports, and in most cases a range of specialists will be involved in the process. We must also consider, however, the position of those people who have only one specialist medical report. The diagnosis may have taken place a long time ago and they may have been living in their acquired gender for many years. I spoke earlier of being reminded by Press for Change of a couple who had lived together for more than 30 years.

Mr Tim Boswell (Daventry, Conservative)

Is there not also an implied situation with relatively recent diagnoses? The national health service criteria for acceptance for treatment might well

require a single diagnosis. Therefore, if the proposal were introduced as a requirement for applications—I will come to adjudications—it might favour those who could seek private diagnosis to supplement their application, and might therefore be discriminatory.

Mr David Lammy (Parliamentary Under-Secretary, Department for Constitutional Affairs; Tottenham, Labour)

The hon. Gentleman makes a good point, and that may well be the case. What justification is there for requiring a person or couple who acquired their new gender many years ago to seek an additional medical report presumably at their own expense? What justification is there for requiring the specialist practitioner or the consultant psychiatrist to spend their time providing a piece of formal evidence rather than doing other work?

I say to the hon. Member for South-West Bedfordshire that it is important to understand the distinction between a psychiatrist and a psychologist and to understand its bearing on the condition of gender dysphoria. Psychiatrists are concerned with the study, treatment and prevention of medical disorders and many will be involved; psychologists are focused on the behaviour of mental processes and how they affect the physical and mental state and the external environment of the individual. Social factors play an important part in the appropriate standard of care that is generally established in the area under discussion. That is why psychologists play an important role.

So we need to be clear about a person who has one piece of medical evidence containing a diagnosis. The panel will have a list of people who work in the area of gender dysphoria. It will no doubt get to know the work of the people on that list pretty well, because we are discussing a small group. In that context we believe that a diagnosis from one specialist is sufficient, especially as that diagnosis is to be buttressed by evidence of living for two years in the acquired gender and proof of the intention to continue to do so permanently.

Amendments Nos. 36 and 37 address the evidence requirements for those transsexual people who are applying under the fast-track provisions on the basis of having lived in the acquired gender for at least six years. Once again, the amendments would require two diagnoses of gender dysphoria: one from a registered medical practitioner practising in gender dysphoria, and one from a consultant psychiatrist. The amendment goes further by specifying that a registered medical practitioner must currently be working in gender dysphoria.

We need to be clear about the effect of the amendments. They would force a number of elderly, transsexual people who apply for legal recognition under the fast- track provisions to get a new diagnosis of gender dysphoria because the medical practitioner who made their original diagnosis is not currently working in gender dysphoria in the UK. That medical practitioner may well now be deceased or have retired. The transsexual person, who may have lived in the acquired gender for decades, will therefore be forced to

incur additional expense and will once again have to expose his or her private life to the scrutiny of the medical profession.

We should also remember that the medical diagnosis is not by any means the only piece of evidence required. The person must prove that he or she has lived in the acquired gender for at least six years in the case of the fast-track provisions, and he or she must also prove the intention to continue living in that gender permanently.

The Government's view is that the amendments would not add substantially to the rigour of the process, and in practice they would simply impose additional costs and burdens on the applicants, the psychiatric profession and the few specialist medical practitioners who work in the area.

Amendments Nos. 40 and 41 relate to the composition of the gender recognition panels. The amendments would ensure that two medical members were on the panel that decide applications, one of whom is recognised as currently practising in the field of gender dysphoria, the other a consultant psychiatrist. The Government are of the view that the amendments are misguided in principle and probably unworkable in practice, and I shall clarify why. First, the medical member is not there to make a diagnosis of the person. The diagnosis is to be provided by the person practising in the field of gender dysphoria who has had direct contact with the applicant.

The medical member is on the panel to ensure that the medical evidence is properly understood and that its implications are properly taken into account when the panel seeks to satisfy itself on the criteria set out in the Bill. I suggest to the hon. Member for South-West Bedfordshire that medical professionals are able to do that. Indeed, this Committee includes a medical member who might be able to make that assessment should he so wish. The panel will also be working with a list of medical practitioners and chartered psychologists who practise in gender dysphoria. That list will be drawn up with the assistance of the professional bodies. In that way, we shall ensure that the evidence comes from reputable sources—practitioners who are respected within their disciplines.

There is also a practical problem with what the hon. Member for South-West Bedfordshire suggests. The transsexual population is small. I have listed the institutions that deal with their condition. If we were to go down the road that the hon. Gentleman suggested regarding the panel, a small group of peers would be judging each other's work. I am not sure that that is desirable or necessary. In light of that, the Government's aim has been to create a robust and credible process, but not to place unnecessary burdens on the applicants that go through the process. It is on that basis that I am unable to accept the hon. Gentleman's amendment.

Mr Tim Boswell (Daventry, Conservative)

I am grateful to the Minister for his explanation, and to my hon. Friend the Member for South-West Bedfordshire for raising the issue. Having

listened to the discussion, I find myself more in sympathy with my hon. Friend in relation to amendments Nos. 40 and 41 on the composition of panels than I do on the amendments that bear on the diagnosis, because I found the Minister's arguments on those persuasive. The only fear I have is that given all the factors that the Minister has expressed—that there is only a small population of transsexual people and an even smaller population of medically qualified personnel or psychologists who practise in that area—there will be only a small pool of people who could either provide evidence or, if amendments Nos. 40 and 41 were successful, appear on panels.

The Minister produced the charming idea that peer review by experts might be in some way less competent at delivering the process than peer review by other medics, including, dare I say, the hon. Member for Oxford, West and Abingdon, who would bring a powerful intellect to bear on such situations. Conversely, given the size of the practice in that highly specialised area, a person with a commanding personality might be able to produce doctrine. Reading across at the widest possible level of generality to issues of cot deaths and paediatrics in which somebody dominated the argument, however good the medical gatekeepers on the panels are it might be difficult for them to challenge the expert advice. Most medics are robust, and later we will discuss the composition and operation of the panels, but it would worry me if there were not some expertise on the panels. The Minister might reasonably reply that if they started as complete ignoramuses they would certainly become expert after a case or two.

The Minister also touched on the ability of panels to access other experts. I am not sure whether he has explained to the Committee's or my satisfaction how the panels would be able to relate to other evidence. I take it from what he has said that they could commission further studies if they felt that there was an unresolved issue. If the initial diagnosis had been

made 30 years ago and the original diagnosing doctor had died, they might want to seek independent advice, for example. The panels must have some firepower to respond to an impassioned diagnosis to ensure that the process does not become too closed or automatic. No more and no less than that would constitute a necessary safeguard.

Mr Andrew Selous (South West Bedfordshire, Conservative)

In tabling the amendments, I did not intend to make the process onerous. As the Minister and several other hon. Members have said, the process should be robust.

Several consultant psychiatrists who practise in the field and have concerns about it assisted me in drafting the amendments. Although I do not expect the Minister to comment—I understand that it is currently sub judice—he will be aware of the case of Dr. Russell Reid, against whom charges have been brought by senior specialists at the Charing Cross hospital gender identity clinic for giving completely inappropriate advice to people wishing to change their gender.

The General Medical Council is currently investigating nine cases and more are being referred to it. That sort of issue shows the need for caution. It shows that the evidence should be robust and that two medical members on the panel would provide a safeguard. Those points were made by Professor Lord Chan, who is respected by members of al parties in the other place.

Dr Lynne Jones (Birmingham, Selly Oak, Labour)

Although that matter is being considered by the GMC, no decision has been taken, so it would be wrong to draw any conclusions from the case of Dr. Reid, who has had great support from the transsexual community for the work that he has done helping many people who have lived in their acquired gender for many years.

It being twenty-five minutes past Eleven o'clock, The chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Two o'clock.