Most of the issues I present you with on this page are fairly nuanced. If you are a regular reader you will probably often react with a thoughtful ‘hmm…’ rather than a ‘damn right!’ or the opposite. But this week I suspect most of you will be very clearly in the latter camp. By which I mean you probably know exactly where you stand on the question that has got so many politicians in trouble over the past few years: can a woman have a penis or can a man have a cervix?
The more cautious of the leading politicians do their damndest to duck the question. Keir Starmer probably wishes he had. But now the health secretary Victoria Atkins, no less, has waded in with an attack on what she sees as the gender ideology that has gripped the health service in recent years.
What is your reaction?
Here’s what Ms Atkins told Sky News: ‘We want to ensure that biological sex is respected (in the NHS) and if someone wants, for example, to have an intimate examination by a person of the same biological sex, then they can make that request and it is dealt with appropriately, and with respect and recognising that person's right to privacy.’ The NHS, she added, must not 'eradicate women' and must avoid using 'artificial language' in the name of inclusivity.
Ms Atkins was speaking ahead of changes that are about to be made to the NHS Constitution – changes that were made necessary by Brexit. The Constitution is the subject of an eight-week consultation closing on June 25.
The changes are important because the Constitution sets out rights for patients, public and staff. The government website describes it thus: ‘It outlines NHS commitments to patients and staff, and the responsibilities that the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. All NHS bodies and private and third sector providers supplying NHS services are required by law to take account of the constitution in their decisions and actions.’
What worries the minister is that ‘gender ideology’ has gripped the health service in recent years. Under the proposed changes, trans women will be banned from female-only wards. Patients who ask for single-sex wards should not be treated ‘like racists’. Women will also be able to request ‘intimate care’ from a medic of the same sex.
Ms Atkins is also worried about the language used by NHS staff. She said it should 'be clear and make sense to people'.
She told Times Radio people ‘are worried about the fact that they see articles in the paper about 'chestfeeding' and language such as that… We are also saying through this consultation that we don't need to eradicate women from our language in order to respect the rights of everyone, women as well as transgender people and men.
She added: 'I would love for it to be business as usual for people to understand that when a woman walks into a maternity unit, we ask her what she wants to be called and if she wants to be called a mother or a mum or a woman, then we all respect that, we don't try to use artificial language…. We have heard farcical stories that claimed patients who demanded to be on single-sex wards were equated to as racists. This cannot be right
Ms Atkins told Sky News: 'We want to ensure that biological sex is respected and that if someone wants, for example, to have an intimate examination by a person of the same biological sex, then they can make that request and it is dealt with appropriately, and with respect and recognising that person's right to privacy and dignity and safety… We just want to make it as clear as possible, both for patients and for staff, that people should be able to make these requests.'
Ms Atkins makes it clear that the rules will also apply to transgender patients – though she acknowledges that that could make things 'a little bit complicated'. But, she said, it is vital that the NHS must not 'eradicate women' and avoid using 'artificial language' in the name of inclusivity. ‘Biological sex’, she said, ‘must be respected'.
So what are the people who work for the NHS making of all this?
Dr Renee Hoenderkamp, a practising GP, described in the Mail a hypothetical scenario which, she said, was all too plausible under the existing rules. She describes seeing the notes of a patient named only as ‘Mac’ which listed serious symptoms but did not make clear whether the patient was a man or woman. So the possibility existed of a biological woman presenting as a man.
The first assessment was done over the phone. Dr Hoenderkamp writes: ‘Mac, wanted an immediate prescription for what sounded like serious symptoms. That sense of urgency makes me cautious, and I ask him to come in for a consultation. There may be nothing in the medical notes, nothing at all, to indicate that Mac is a trans patient.’
But, writes the doctor, one simple question — 'Were you born female?' — ‘could prove a lifesaver,’ She continues: ‘In the current climate I might hesitate to ask directly. If Mac does indeed have early-stage ovarian cancer, that's something that I could never have surmised from the notes… The NHS's obsession with 'trans rights' is deeply dangerous in many ways, not least to the trans men and trans women whose medical records do not reflect that they identify as the opposite sex. They might even have obtained a new NHS number to eradicate their history.’
Dr Hoenderkamp welcomes Ms Atkins' declaration that 'biological must be respected' even though it ‘cannot undo all the damage wreaked in the past decade by trans dogma’. But, she says, ‘it is a crucial step in the right direction.’
She still has serious misgivings, however, about the change of direction because ‘It comes far too late.’ She describes herself as ‘one of many women doctors who have been warning about these problems for years, and our voices have been comprehensively ignored until now. The Secretary of State's pledges do not go nearly far enough — and already we are seeing resistance from outraged trans activists within the health service, who will fight to prevent any changes to the NHS constitution.’
Dr Emma Runswick, the deputy chair of the British Medical Association council, is one of those activists whom Dr Hoenderkamp has in mind. She has attacked the proposals because, she says, they will be subject to an eight-week consultation period ‘during which they are at risk of being completely reversed or once again watered down until they are meaningless.’ And, she says, they have 'the potential to incite further discrimination, harassment and ostracisation of an already marginalised group. Transgender and non-binary patients will potentially find their access to vital NHS services limited'.
Matthew Taylor, the chief executive of the NHS Confederation, which represents hospital trusts, told ministers it was important that the NHS is not ‘dragged into a pre-election culture wars debate.’ He says ministers would be better ‘bringing forward detailed plans to improve NHS funding, tackle the decrepit state of many health facilities and get waiting times for A&E care and planned surgery back to the levels that existed when the constitution was first published in 2012’.
Mr Taylor described the proposed new guidance itself as ambiguous: ‘It does not explicitly tell hospitals that they should routinely put a trans person in a single room. But it appears to presume that this will generally happen…It says that, when hospitals are considering how the long-established single-sex wards policy should apply to those who have changed gender, the needs of every patient on the ward should be taken into account.’
So where do you stand in this debate? The question is not whether trans people have rights when it comes to their treatment at the hands of the NHS. That is a given. The NHS exists to serve us all. The question is how those rights can be balanced in a way that enables medical staff to treat all their patients with respect.
Let us know what you think.
