Wes Streeting
MP for Ilford North · Labour · United Kingdom
“We hope for the best and plan for the worst in terms of the continuation of this war, but we are also actively working to prepare for conditions in which a ceasefire has been agreed by Ukraine, with Ukraine and, from our perspective, for Ukraine.”
“The threats we face are not only evolving; they are getting closer to home. Every day, the UK and our allies encounter espionage, cyber-attacks and military posturing by hostile states.”
“One discipline I have to bring to the Ministry of Defence, drawing on my experience at the Department of Health and Social Care and the NHS, is to ensure there is no culture of routine overspending, that we are improving productivity, that we deliver value for money and that we recognise that the money we are investing in defence comes wi…”
“With permission, I will make my first statement to the House as Secretary of State for Defence on Ukraine, the ongoing threat from Russia and the Government’s approach. It is not yet clear whether freedom or tyranny will define the 21st century. What is clear is that the United Kingdom will not be a bystander in that struggle.”
“I am grateful to my hon. Friend for raising that very serious and important issue. She will understand that, as a matter of policy, I will not comment on intelligence, but I will address the reports she has raised.”
“We know that this Prime Minister and this Chancellor are both fully committed to funding our nation’s defence, including meeting our NATO commitment of 3.5% by 2035 and setting out an earlier 3% commitment at the next spending review.”
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“I am sure that I will be able to swing by on my rounds. It is so important, especially against the backdrop of the crisis that the NHS has been through over many years, that as well as celebrating the best performance, we celebrate when there is real improvement. My hon. Friend knows as well as I do that there is of course more to do, but it is to the credit of leaders and staff that there has been improvement—lots done, and a lot more to do.”
“This is an issue that the Government are looking at. As with all treatments, we should be following National Institute for Health and Care Excellence guidelines, but I recognise that in this area there is a degree of regional variation in provision in a way that, frankly, I find difficult to justify. We are looking at this and, as we make decisions, we will of course report on progress to the House.”
“This Government are putting record levels of capital investment into the NHS to correct more than 14 years of Conservative failure. We are using public investment. We are certainly learning the lessons of the past in relation to PFI. We are able to do that only because people voted Labour and elected a Labour Government. I look forward to working with the city’s Labour MPs to deliver the improvements in services that it deserves.”
“I am grateful to the hon. Member for her question. Although of course we are considering prevalence and what is driving the apparent increase in conditions such as autism and ADHD, we are really driving at ensuring that we meet everyone’s needs. I do not want for this country a future in which those who can afford it pay to go private and those who cannot are left behind. Nor do I want to see a situation in which people who have a diagnosis do not receive the care they need. We are looking at those issues with urgency.”
“I certainly join the hon. Member in his final message and commend him for his declaration, because the more we can break taboo and stigma around these issues and get people talking more openly about the telltale signs of risk, the better protected we will all be. As he will know, we are looking very carefully at the recommendations around screening. I will be convening a group of experts with the chief medical officer to probe some of the recommendations, and I will keep the House informed.”
“Of course, I endorse what my hon. Friend said. Waiting lists are falling for the first time in 15 years. Lots done, and so much more to do, but with Labour, the NHS is on the road to recovery.”
“The hon. Member is quite right to hold the Government’s feet to the fire on this issue. We are having cross-Government discussions about this issue and other groups of victims of state failure. We will keep him and the House updated.”
“The hon. Member is absolutely right, and that is why a big part of our modernisation approach is to shift care out of hospital and into the community, making greater use of community diagnostic centres, community pharmacies and GPs. As his question shows, 18 months in, lots done, but a lot more still to do.”
“It is not comfortable, but I do believe it is the right thing to do, on balance.”
“Use in those cases has been extensively tested and has met strict safety requirements for that use. The study is led by King’s College London and the South London and Maudsley NHS foundation trust. It has been carefully checked by independent scientists who advise the National Institute for Health and Care Research and by the Medicines and Healthcare products Regulatory Agency, and received approval from a research ethics committee. I am treading cautiously in this area because the safety of children must come first.”
“The bar for the trial to be approved was extremely high and oversight will be rigorous. Children cannot consent to being on the trial, so places will require parental consent, as well as the assent of young people. It is because protecting and promoting the health and wellbeing of affected young people is our primary concern that there are also strict eligibility criteria in place to join the pathways clinical trial. As such, the number of young people who would expect to qualify for the trial will also be low. Participants must undergo thorough mental and physical assessments and will be followed over a number of years with regular wellbeing checks. Puberty blockers have also been used to delay puberty in children and young people who start puberty much too early.”
“Member for Louth and Horncastle (Victoria Atkins), a permanent one. Dr Cass also recommended a thorough study to establish how best to support children and young people who suffer gender incongruence. That is the pathways study. The study has four main parts, one of which is the clinical trial to study the effects of puberty-suppressing hormones on young people’s physical, social and emotional wellbeing. The other aspects of the pathways study will track the physical, social and emotional wellbeing of all young people attending UK NHS gender services. It will look at young people’s thinking and brain development, following both those who are and are not taking puberty-suppressing hormones, and it will gather evidence directly from young people, parents and staff about their experiences of living with gender incongruence.”
“Let me just start by acknowledging the sensitivities around this issue and the strong beliefs held around this House. For all the division and divided opinion, I believe that there is a determination shared by everyone in this House to do the right thing by a vulnerable group of children and young people. It is for those reasons that I am taking the course of action that I am. Put simply, that is to follow expert clinical advice and take an evidence-led approach. The Cass review found shocking levels of unprofessionalism, a lack of clinical oversight and puberty blockers prescribed to children without sufficient evidence that doing so was safe or beneficial to those children and young people. What Dr Hilary Cass uncovered was a scandal. That is why, on coming to office, I made the temporary ban brought in by my predecessor, the right hon.”
“I accept that there were many well-meaning people involved in these services at the Tavistock clinic, but the fact that Dr Cass found such a lack of rigour, such a lack of standards and such a lack of proper oversight is disgraceful. It is the clinicians who are well meaning and ideologically driven who have given me the most cause for concern in this whole debacle and who have done more harm to children, young people and the trans community than most other people who have taken part in this debate. I appreciate the work that Dr Cass has done, and I am glad that she is in the other place, bringing welcome scrutiny. Were she not supportive of this approach, I might think again, but she has made her recommendation and given her support. I am following clinical advice.”
“In order for anyone to participate in this trial, it has to have the most robust clinical oversight from clinicians within the service, as well as national oversight and the consent of parents. It is only where young people will be deemed to benefit that they will be on this programme. The shadow Minister asks about the data linkage study. That is important. The data linkage study will be undertaken, but when it is completed it will not provide us with the same evidence as this clinical trial. That is why Dr Cass made a distinction between this trial and the data linkage study. The hon. Lady also asks about the motivations of those who withheld data. That is an extremely important question. It is utterly appalling that anyone in a position of responsibility in the NHS withheld data on a very vulnerable group of children and young people.”
“I accept that there is now a difference on this particular recommendation, but I would urge Members not to walk away from the cross-party consensus we built behind that approach but to build on the work that Dr Cass has done. Let me turn to the important questions raised by shadow Minister. There will be two groups within the trial, as well as a further control group of children and young people with gender incongruence who do not receive puberty-suppressing hormones. At least 226 participants are required in order to detect a statistically significant difference between the two treatment groups. However, this is not a target and no young person will find themselves on this trial because there is a drive to make sure that a certain number of young people are participating.”
“The reason I was uncomfortable with that, too, is because I had to look children and young people, and their parents, in the eye when they told me in no uncertain terms that that decision was harmful to them, as have many other clinicians who have opposed that decision. Whatever my discomfort in this extremely sensitive area, the reason that I have made this decision is that I am following clinical advice and, as Health Secretary, it is my responsibility to follow expert advice. Had the Tavistock clinic faced such challenge and scrutiny a decade ago, we would not be in this mess. The Conservatives were right to commission the Cass review and they were right to accept its recommendations.”
“The Conservatives may have changed their tune in opposition, but I remember what they said in government when they published the Cass review and supported its recommendations, so I think their response now is a real shame. The shadow Minister accuses me of inconsistency, so let me be clear. Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that. Am I uncomfortable about puberty-suppressing hormones for this group of young people for this particular condition? Yes, I am—because of risks. It is why I was also uncomfortable when I upheld the temporary ban by my predecessor and then put in place a permanent ban.”
“The shadow Minister asks, “Why?” There is a simple answer. It is because this was recommended by Dr Cass in the Cass review, which was commissioned by my predecessor, Sir Sajid Javid. I think that was the right thing to do, and it is why, when my predecessor brought forward the Cass review, I supported it in opposition. I certainly did not try to play politics with an extremely vulnerable group of children and young people. I will tell the hon. Lady why. It is because, under the previous Government, those puberty-suppressing hormones were prescribed without proper oversight, supervision or safety, yet we did not hear a peep about that fact for years until Dr Cass, commissioned by Sir Sajid Javid—who deserves enormous credit—did the study, which was published and widely supported and which contained this recommendation.”
“The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.”
“NHS England has opened three new children and young people’s gender services in the north-west, London and Bristol, with a fourth planned for the east of England in 2026. We aim to have a service in every region of England in the coming years. These services use a different model with multidisciplinary teams, including mental health support and paediatrics, within specialist children’s hospitals to provide good clinical care. The new services will increase capacity and reduce waiting times so that patients can be seen sooner and closer to home. We have also commissioned additional support for young people waiting to be seen through local children and young people’s mental health services.”
“I can absolutely assure the hon. Member that we are doing that wider research and that of course we will take into account high-quality international evidence, as well as the research we are undertaking domestically. It is so important that we recognise that, for many young people with gender incongruence, even if approved, puberty blockers will never be the right medication. One of the things I have been most saddened by in the discourse among adults in this debate, many of whom should know better, is the elevation of puberty blockers to the status they have received in public discourse and debate; many young people out there think not only is this the gold standard of care, but that it is the only care available, and, of course, that is not true.”
“We have to have this debate with due care and sensitivity for young people in this vulnerable group in particular and for the wider trans community, who feel extremely vulnerable in this country at the moment, including as a result of decisions I have taken as the Health and Social Care Secretary. We have to consider all of that in the round, but we must make sure that at all times we are following the evidence, that we are open to scrutiny and challenge, and that where we are making these finely balanced judgments, we are doing so with rigorous debate, testing the arguments, the evidence and the data. That is why I welcome the urgent question and this discussion.”
“Let me reassure my hon. Friend and the House that I am absolutely open to receiving representations and evidence from clinicians involved in the care of children and young people, with insight, expertise and data, including those who might be critical of the approach that the trial team is setting out or, indeed, critical that the Cass review included this recommendation. That is important because the many things that have gone horribly wrong in this area have included the silencing of whistleblowers and the silencing of rigorous debate and discussion.”
“I have sought at all times, including when I sat on the Opposition Benches, to treat this debate with the care, sensitivity and humility it deserves, and not to be tribal in my interactions. I only wish this Conservative Opposition would take the same approach.”
“I certainly do not need to be told what my responsibilities are on this. I always take responsibility for the decisions I take. I acknowledge the extent to which the hon. Gentleman and members of his party seek to weaponise this issue, and to personalise it. [ Interruption. ] We can simply refer back to his question and to the shadow Minister’s reference to the “Streeting trial”—if that is not personalising, I do not know what is. I’ll tell you what: I will take an evidence-based approach. I have done that on this issue from day one. Had the Conservatives done so, we would never have seen the Tavistock scandal. We would never have seen puberty blockers dished out willy-nilly to children and young people in this vulnerable patient group.”
“I do think we have a high-quality trial set up. I do have confidence in the clinicians. We have had a cross-party briefing from the clinical team. I am happy to repeat that exercise, to keep coming back to the House and to arrange briefings for MPs and peers on a cross-party basis so that we can follow this closely, as we should.”
“My hon. Friend is absolutely right that we must engage with due care and sensitivity on this issue. I can share with the House that these exchanges, Government policy, what is said by me and others, are followed extremely closely by this group of children and young people, who are extremely online, and by the wider LGBT+ community. My hon. Friend is right that trans people are often at the wrong end of the statistics as victims of hate crime, discrimination and mental ill health. We must always tread carefully when talking about suicide in this context, and bear in mind the warnings of the Government’s adviser on suicide prevention, Professor Louis Appleby, and the way in which that issue has been deployed irresponsibly by critics of the ban on puberty blockers that was put in place—we bear all those things in mind.”
“The young person and their parent or guardian must clearly demonstrate a full understanding of all these issues—only then, after that, would a clinician sign off on admission to the trial.”
“Anyone on the trial can choose to stop taking puberty-suppressing hormones and leave the trial at any time; they do not need to give a reason. If a young person decides to stop taking puberty-suppressing hormones, their care in the NHS, including the gender service, will not change in any other way, and their doctors will explain to them and their parents or guardians what treatment options are available. I know that there are concerns about the longer-term impacts on fertility. Prospective participants will be given comprehensive information on the advantages and potential risks of the hormones, including details about preserving fertility. Doctors will explain the possible long-term consequences and available options. Young people will also be offered consultation with a fertility specialist.”
“I first thank the right hon. Member for the way in which he puts his concerns. I know he is concerned about this trial and that he has stated publicly his opposition to it, and I enormously respect the way in which he has done that. These are finely balanced judgments, and I acknowledge that. The Cass review found that puberty blockers have been prescribed routinely without good evidence for their safety or effectiveness, and that is why a clinical trial was proposed. They are licensed and used safely in much younger children for precocious puberty or in older adults for certain cancers. For adolescents, the interaction with all the different processes of puberty may be very significant, which is why more evidence and a better understanding of their impact is needed in this patient group.”
“As I reported when we put in place the permanent ban, there have been arrangements for people who were previously being prescribed puberty blockers. People who wanted to access them, but could not once the ban came in, have not been able to do so through authorised means. I recognised when I took the decision, and as a result of representations I have received, both directly and in writing, that it caused considerable pain and distress to a very vulnerable group of children and young people and to the people who care very much about them. I have not been indifferent to that; I have taken it very much into consideration. However, with respect to all the people I have met, no amount of political pressure should move a Health Secretary away from the clinical advice and expert opinion that should underpin these sorts of decisions.”
“That is the approach that the Government are taking. I realise that decisions that I have personally taken have not been received in that way. That has not been comfortable for me, but I do believe it has been the right thing to do.”
“I am grateful to my hon. Friend for that question. I recognise that the decision I took, within days of coming into this office, was received by trans people in particular, and the wider LGBT+ community, as a negative decision that detrimentally impacted their rights and identity. That is why it was an uncomfortable decision for me to take; I knew how it would be received and had to balance up the risk. I believed—and still believe, by the way—that it was the right thing to do, for the right reasons: a clinically led decision. When it comes to the care and health of children and young people in particular, I make no apology for exercising extreme caution. I do want trans people in our country to know that this Government respect them and their identity, and want them to live with dignity, safety and inclusion.”
“That is why we have to tread extremely carefully in this area, to follow evidence and to build an evidence base. It is also why these are such finely balanced judgements and why I can be simultaneously uncomfortable with the permanent ban that I put in place and uncomfortable with the clinical trial. I hope that I have reassured people that I think very deeply about these issues before taking decisions.”
“Whatever my discomfort and personal views about this particular trial or about the notion of young people using puberty blockers in this way, I cannot ignore, and should convey faithfully to the House, conversations that I have had with trans young people and adults. They have described in powerful and unforgettable terms not just the life changing, but the life enhancing experience that they have had. I am thinking particularly of the university student I met; if she walked into this Chamber now, we would assume that she was born female. She is living her best life and described in very powerful and unforgettable terms the impact that treatment has had for her and her quality of life. At the same time, I think of high-profile cases such as Keira Bell’s.”
“I thank the right hon. Gentleman for his question and for how he puts his criticism, too. As I said earlier, and for the avoidance of doubt, I know what my responsibilities are. I understand the decisions that I take in this office and that I am accountable for those decisions. I do not resile from that. I am following clinical advice; I think that is the right thing to do in this area. On the question of sex, the right hon. Gentleman is right: sex is immutable. Even if there has been treatment with hormones or surgery, underlying biology none the less means that trans women, for example, would still need to be screened and treated bearing in mind their biological sex, and the opposite is true for trans men. We have to draw that distinction between biological sex and gender identity.”
“I am grateful to my hon. Friend for his question. The reassurance that we can provide trans people in our country is that we are committed to making sure that they have access to the highest quality, evidence-based healthcare. That does not just apply in the case of children and young people; I also hope to report to the House before the Christmas recess the work undertaken in the Levy review into adult services. We are committed to making sure that we provide high-quality care to a particular vulnerable group of children and young people.”
“I am grateful to the hon. Member for the way that she asks her question, as a critic of some of the decisions that I have taken in this space. The reassurance that I can offer is that the study will look at the holistic care that this group of children and young people receives, and ensure that wider evidence-led therapeutic support, including mental health support, is available, so that regardless of whether a young person receives puberty blockers, they will certainly receive that wider range of support.”
“I will try to do that, Madam Deputy Speaker. We will ensure that young people get good access to wider evidence-led support. I have had to wrestle with the fact that some trans people enter adulthood without ever receiving any sort of healthcare, and I have been heavily criticised by those people in particular for some of the decisions that I have taken. We are working to reduce waiting times, as I have described. My hon. Friend says that puberty blockers are reversible. We hear contrary views about that from Members across the House, some of whom say that puberty blockers are irreversible. The truth is that the evidence in this area is mixed, which is why we need to build a stronger evidence base.”
“The right hon. Member is right that we need that data linkage study. That will happen, but it will not produce the same evidence base as a clinical trial, and that is the distinction between the two. It is frankly a disgrace that people have sought to withhold that kind of data and it is really important that we get this right. I appreciate the right hon. Member’s sympathy. I have wrestled with this issue probably more than any other ethical decision that I have had to make in this office. I do not seek any pity or sympathy for doing so—it is the job that I signed up to and a job that I love doing. I have taken great care and sensitivity in this area because of the particular vulnerability of this group of children and young people.”
“When it was published—I was in the Chamber at the time—there was an overwhelming consensus in the House. There were some people who criticised and challenged the Cass review at the time, including some outside the House in the LGBT community. I have always supported the Cass review, which was led by one of our country’s best paediatricians. Because of that, I am proceeding in the way that I am, which is the way that Dr Cass—now Baroness Cass—recommended. I will continue to follow the evidence and implement the Cass review comprehensively.”
“I will take the hon. Member’s question in three parts. First, the opinion polling that she mentions shows that people in this country are overwhelmingly kind, and they want to ensure that trans people, and LGBT people more broadly, are treated with kindness, compassion and inclusion. Secondly, I do not dismiss the opinion polling that shows that a majority are against this kind of trial. Thirdly, the reason I am doing this is that I have to think about this extremely small group of people. I do not know what it is like to walk in their shoes and I have to think very carefully about what is in their best interests. The best way to do that is to build the evidence base that we need to provide high-quality healthcare. I strongly, strongly do not agree with her characterisation of this study, which is in itself irresponsible.”
“My hon. Friend is correct that the study is about building the right evidence so that we get high-quality, safe healthcare for this vulnerable group of children and young people.”
“I assure the hon. Member that as part of this study, and as part of the roll-out of services across the country, we are focusing on the therapeutic support that she describes. We are implementing the Cass review, which recommended this particular trial for this particular purpose, and we will follow the evidence. Of course we look at what other countries are doing, why they are doing it and what research emerges.”
“My hon. Friend is absolutely right. Regardless of whether people are receiving this medication or not, we need to ensure that they receive the right therapeutic support to enable them to have healthy, happy childhoods and to understand themselves, the world they live in and how they relate to it in a way that does not cause them distress or harm. That is my objective in this process.”
“I do not doubt the hon. Member’s sincerity and integrity on this issue, but I say to her respectfully that when she talks about barriers to entry, those “barriers” are safety and clinical oversight, as well as parental consent and the assent of the young person. I do not believe that those are barriers; I believe that those are necessary bars for participation in this trial.”
“The way in which the trial is established will help us to distinguish between the benefits of receiving or not receiving this particular medication, and there will be really close oversight of the impact on development, but he is right that we need to judge these things on the question of risk. That is what led Dr Cass to make her recommendation, and that is why I support it.”
“May I thank the hon. Member for the way in which he put his question? It is so important to emphasise that right across this House, there are many people who oppose this trial, but who do want to see trans people well supported and protected and to respect their identities. That is important for everyone to bear in mind. The hon. Member talks about placebo. For obvious reasons in this case, a placebo would not be appropriate, because it would be very obvious whether a young person was receiving the real medication or the placebo, but the trial design has included a control group.”
“I am very happy to receive further clinical representations on this issue and to hear from experts on it. I hope the public will understand why, on this particular issue, I am not simply led by opinion polling. I have to follow the clinical advice and evidence, particularly given the enormous risks that surround these children and young people, including the risks that weighed on my shoulders and conscience when I denied access to puberty blockers by upholding the temporary ban and then making it permanent.”