| Gender Recognition Bill [Lords]
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Andrew Selous: 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. Lammy: 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 Column Number: 26 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. Boswell: Is there not also an implied situation with relatively recent diagnoses? The national health service criteria for acceptance for treatment might well Column Number: 27 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. Lammy: 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 Column Number: 28 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.
11.15 amAmendments 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.
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