The Cass review is a considered, evidence-based report that was drawn up by experts. It was led by Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health, and it involved clinicians and young people themselves. We must not ignore Dr Cass’s conclusions, no matter how difficult they may be, as failure to implement all those that apply to the NHS in Scotland would let down both staff and a generation of young people and their families.

Let me turn first to the Scottish Government’s response. The pretence that the Government knew nothing about the review and needed lots of time to consider the report does not hold water, frankly. Meetings took place with Dr Cass, senior clinicians and the Scottish Government well before publication of the final report. Just to be clear, the deputy chief medical officer was there, along with a host of senior Government officials. Let us not forget that there was also an interim report, which set out the direction of travel quite clearly.

The lack of leadership from the SNP Government has been woeful. The unseemly backwards and forwards between the Scottish Government and health boards about who would make the announcement about the pause in puberty blockers was, I thought, quite disgraceful. Instead of taking ownership, the minister chose to leave the burden to the same clinicians who have expressed concerns about the toxicity of the conversation on gender services that is leaving them vulnerable and exposed. It is no wonder that NHS Greater Glasgow and Clyde has struggled to recruit consultants at the Sandyford clinic. Staff at the Sandyford clinic do an incredible job, but they are not adequately supported to do so.

The Scottish Government published the NHS gender identity services strategic action framework in 2021, and we welcomed it. The national gender identity healthcare reference group was set up in March 2022 to oversee implementation of the framework, and I note that the deputy chief medical officer co-chairs the group. The reference group’s latest minutes report that the negative impact of the on-going polarised public discussion has taken a toll on the recruitment of staff in gender services. Dr Cass echoed those concerns in her report, stating that there are

“few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.”

The Government must take leadership in that area.

However, the framework also impacts on recruitment and it has a knock-on effect on waiting lists. I remember that, when the framework was published, waiting lists were sitting at about four years. They are now sitting at about four and a half years for young people and five and a half years for adults. That is unthinkable. Why is the minister bypassing the already established national gender identity healthcare reference group? Why is the new group being set up when there is one with all that expertise sitting round the table? How is it intended to link the two, or will they exist in splendid isolation from each another?

I understand that National Services Scotland is in the middle of commissioning gender services. Will that include the use of puberty blockers and hormone treatments? If so, from what age? Those are critical questions.

Let me deal briefly with the Labour amendment.