GENDER-AFFIRMATIVE HEALTHCARE, ACTUAL GREEN PARTY POLICY AND CASS

On 28 July, LGBTIQ+ Greens contacted all candidates, including Deputy Leader ones, with a pledge request and a deadline of 31 July for responses. Those received were published and circulated on 1 Aug on day of ballot opening. There seems to have been quite a low response rate. Some candidates have since stated they had pressure of time and others that the format was not appropriate (citing advice from the ERO). A Twitter user commented, with an illustration, “More than half asked either didn't fully support or didn't think it important enough to respond to the pledge?”

I will set out my response here (also available as pdf). Firstly, I am certainly not one of those for whom the inference can be drawn I didn’t think it important enough to respond. Last year, as a leadership candidate, I did produce a longer response to a similar set of pledges and these can still be viewed here. These historical responses should still be of interest to voting members today because they will demonstrate consistency in my thinking and statements and also show that I have been able to anticipate some big political issues of the day. I also raised the alarm about GIDS in a motion to conference in Spring 2021, and endured sustained harassment for it by some.

This year, I was in correspondence with LGBTIQA Greens before the deadline about whether they could allow a more detailed response outside the format of the pledge request, which only allowed Yes/No answers on each pledge. I was willing to supply a link as I did last year but it seems they did not approve this idea.

I am going to focus on what I take to be the most controversial pledge:

Support gender affirming healthcare for trans youth, rejecting ideological interference with current practice.

I cannot agree to this pledge as stands as at best it does not clarify what gender affirming healthcare is and on the standard meanings it is not something I can support. Let me define it with a view to saying that I believe the Green Party policy would strongly support my stance.

A broad definition would encapsulate a range of approaches to care and treatment, including social, psychological, legal and clinical. But options for treatment should not be prejudiced towards affirmation of gender, absent a thorough assessment of the individual. That prejudgment, contrary to the implication of the pledge, would itself betray an ideological bias, not necessarily in the patient interest.

The focus of the gender-affirming model of healthcare is normally in clinical contexts, as a way of justifying medical interventions, such as puberty blockers, hormone therapy and genital surgery, all aimed at supporting the patient to live in the gender that does not match their natal sex. These medical interventions are some of the most controversial – because experimental, irreversible or hard (some might say impossible) to obtain age-appropriate consent for. The thresholds for referral and clinical due diligence for implementation are currently the subject of a wide-ranging review into NHS treatment standards and options for patients who may be presenting with gender distress, incongruence or dysphoria.

We should be thoroughly conversant with the progress of the Cass Review, its interim report and the reasons for the announcement, which broke just last week, to close the GIDS clinic at Tavistock. That closure announcement followed the culmination of years of whistleblowing from clinicians, David Bell and Sonia Appleby, and patients at the Tavistock, most notably Kiera Bell (which led to the judicial review in Dec 2020). We should also be concerned at the historically sharp rise in child and adolescent referrals to GIDS, such as over the period shown below 2009-16, particularly affecting females.

So what should the Green Party be saying about gender affirming healthcare in this context? Firstly, for avoidance of doubt, we do not have an explicit policy on gender affirming healthcare (the relevant sections are Rights and Responsibilities and Health). Judging from statements regularly and repeatedly made, or amplified in public, by some Greens, you might have assumed the contrary. To repeat: Gender-affirming healthcare, as an ideological approach, is not Green Party policy.

We do however have policy that would chime with the very deliverances of the CASS review, which stated:

A comprehensive patient and family centred service and package of care is needed to ensure children and young people who are questioning their gender identity or experiencing gender dysphoria get on the right pathway for them as an individual. (Cass to NHS England, 19 July 2022)

This is not gender-affirming healthcare as it does not prejudge the end goal. It is, moreover, entirely consistent with the values and statements of our health policy, for example, take this opening section:

HE300 This policy sets out how services will be delivered and regulated. It expands on our values and principles where necessary but it will not make judgements on individual treatments or medicines unless as a point of principle.

In so far as gender-affirming healthcare attempts to push for a general course of action, without sufficient evidence or exploration of alternatives, it is inconsistent with this Green Party policy to treat each individual according to the merits of each case.

Under Assessment of Treatments (HE1408-HE1411), we say:

The effectiveness of treatments will be assessed by the [independent healthcare] agency using the best clinical evidence available. The agency will use independent panels of experts to assess treatments. The agency will assess the effectiveness of treatments across the entire health care spectrum, from synthetic pharmaceuticals and surgical procedures to public health interventions and complementary therapies. (HE1408)

This sounds remarkably like what the independent CASS review is doing.

Nor is it the case that Party policy would avoid consideration of budgetary constraints in assessing the overall viability of treatment options:

The agency will produce recommendations that compare effectiveness against cost allowing the NHS to decide which treatments are required to meet the needs of the service within its budget.

CASS has emphasised holistic, multidisciplinary care in its new offer to patients referred for gender distress, and wants to ensure greater attention to potential co-morbidities:

The centres should have an appropriate multi-professional workforce to enable them to manage the holistic needs of this population, as well as the ability to provide essential related services or be able to access such services through provider collaborations. These should include, but not be limited to: mental health services; services for children and young people with autism and other neurodiverse presentations. (Cass to NHS England, 19 July 2022)

This alternative approach is remarkably consistent with what we say in Health:

HE1409 Whilst assessment of treatments must be evidence based, an holistic approach will generally be taken. This will take into account the range of factors in health and disease, wider benefits and health outcomes than addressing a single illness and a full assessment of side effects and risks to the patient and to society. Treatments that target the causes of ill-health will be favoured over treatments that simply target symptoms.

So, in response to the pledge, in a nutshell: I do not support a gender-affirmative approach to healthcare, but an evidence-based, holistic approach that does not predetermine the source of the gender distress. My approach is entirely consistent with actual Green Party policy.

The other pledge which I cannot support in the format given is the Conversion therapy bill. Yes, all of us is against conversion therapy as such (as stated in our policy under HE1003) – and I have signed up to the general principle even in my responses of 2021 (linked to earlier). But the original government bill risks criminalising therapists who would prioritise talking, exploratory therapy; not with the aim of denying their patient gender affirmation but for confirming the diagnosis (or not).

I have addressed this topic in the LGBTIQ+ Greens hustings and you can playback my response to Zack Polanski’s disreputable attempt to smear me at the same time (smears I have asked him to retract).

Members have the opportunity to vote for the Deputy Leader candidate who would put science front and centre of their thinking, as should all Greens, whether in medical science or climate emergency. #BackReality

Coda.

As a caveat, there should be no doubt that the Green Party is allied to science not ideology. Our health policy is shot through with reference to objective science and authoritative medical scientific bodies, to which or whom we would remain answerable. Some examples:

On single sex wards and patient dignity:

HE204 To ensure that health care services are delivered with compassion, taking into consideration patients full range of needs, health care will be delivered in an environment that promotes healing and care. This includes single sex wards in hospitals, ensuring that maternity care is of the highest quality, ensuring that care reflects people's needs and that care promotes the dignity of all patients.

Teaching of biology in schools (in context of pregnancy section):

The Green Party would implement medically-accurate abortion, pregnancy and childbirth education for all genders into its education policy. Nobody should leave school unaware of the medical realities of reproduction. (HE701)

Avoidance of unscientific or ideological bias in medical settings:

The Green Party would ensure that all medical staff involved in publicly-funded counselling and healthcare involving a person’s reproductive health are committed to providing unbiased, patient-led, and medically accurate advice, regardless of their personal moral convictions. (HE704)