'Toxic' trans debate leaves NHS Scotland struggling to recruit gender ID clinicians

Professor Sir Gregor Smith warns the NHS could struggle to recruit staff to its gender identity clinics

Scotland’s chief medical officer says the NHS will struggle to recruit staff for its gender identity clinics because of the “toxic” trans debate.

Professor Sir Gregor Smith said politicians needed to show “leadership” in making society more “tolerant” of trans issues if the NHS was to maintain a proper workforce in its clinics.

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He made the comments while being questioned by Holyrood’s health committee on Tuesday on the Cass Review, which led to the pausing of prescriptions of puberty blockers for children in Scotland.

Sandyford is the specialist sexual health service for Greater Glasgow and Clyde. Picture: John DevlinSandyford is the specialist sexual health service for Greater Glasgow and Clyde. Picture: John Devlin
Sandyford is the specialist sexual health service for Greater Glasgow and Clyde. Picture: John Devlin | John Devlin

Prof Smith told the committee: “I have spoken to clinicians working in this area and they speak about the great difficulties they have, partly because the external discussions about these services are toxic. We need to change that dialogue.”

He added: “If we don’t change that argument, the toxicity of the discussion means it will be very difficult to attract clinicians to work in that space in the future.

Gregor SmithGregor Smith
Gregor Smith

“No matter how much work is put in place to develop a service that is fit and appropriate, it will still be difficult to attract clinicians into the space if the toxic discussions at a societal level don’t change.”

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Prof Smith also made a direct plea to politicians to show “leadership” on the issue to make what was a “challenging job” easier for NHS staff.

He said: “We need a different dialogue for a society, which is more tolerant of the differences people experience. If we can do that, it will create a different environment for those who want to work in this area.

“We have the ability to change this national dialogue and I ask for leadership in assisting us to do that so we can attract the workforce needed to provide the care we want to provide.”

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The Cass Review looked at trans healthcare for children and young people and was published in April by paediatrician Dr Hilary Cass for NHS England.

At the health committee at Holyrood, MSPs were told it would be wrong to suggest Scotland had merely just copied what was happening in NHS England, as NHS Scotland was in dialogue with Dr Cass from the beginning.

Following the publication of her report, the Scottish Government formally paused the prescriptions of puberty blockers after it was found the justification for their use was “remarkably weak”.

Following the report’s publication, Dr Cass said critics were spreading misinformation about her work. At the time the British Medical Association (BMA) called for the pause on puberty blocker prescriptions to be lifted.

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However, last month the doctors’ union decided to take a neutral position on the matter after 1,000 senior doctors wrote an open letter to the BMA expressing concerns with this stance.

SNP MSP Joe Fitzpatrick also questioned Prof Smith on the BMA stance during his appearance at the health committee.

Prof Smith admitted it was a “controversial moment” when the BMA criticised the Cass Review. He said the union had “moved back” from its initial position.

Prof Smith said the union had referred to two papers published online when critiquing the review, and these papers were “not peer reviewed”. He said one was more of an opinion blog piece than a research paper.

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