 Mae'r byw yn gyd ors, mae'r ddau yma wedi cwestiwn hwn yn gyrdychol, a'r byw'r wych yn erbyn dweud. Be' ffawr yw'r newid gydaлаethas ac mae'r ddau. Felly, mae'r ddau yn ei ddweud i'ch gael ei ddweud i gael i'r ddweud ac i gael i'r ddweud ac i gael i'r ddweud i'r ddweud? Mae'r ddweud i'r ddweud i'ch gael i'r ddweud i'ch ddweud i'ch gael i'r ddweud i'ch gael i'r ddweud a'i ddweud mewn gwneud. Here we will hear from two expert panels as part of our stage one evidence on the gender recognition reform Scotland Bill. The committee had hoped to hear evidence from Professor Alice Sullivan as part of today's first panel and, although Professor Sullivan was not able to join us today, I am pleased that she has accepted our invitation and should be with us on Tuesday, 21 June. We had also hoped to hear from Dr Hilary Cass as part of today's second panel. Dr Cass has declined the committee's invitation, indicating that she has published her interim report and referring us to that and other published statements that she has made. Cwyrdys also invited a number of respected associations representing medical professionals, but several have declined the committee's invitation to then in person today, and some have agreed to give written evidence which the committee will be able to consider as part of our stage 1 inquiry. Last week, the committee heard from witnesses representing faith groups and secular society. As committee members are aware, ahead of that session, the committee had approached a number of a range of faith groups, but for a variety of reasons they declined our invitation to attend last week, and I hope that that provides clarity for those following the committee's work. Going forward, as agreed by the committee, clerks are working with a variety of parents groups to organise an informal evidence session in order that we can hear from parents whose children have a transgender identity. Clerks are also looking to arrange for the committee to hear informally from people who have transitioned and then have chosen to reverse the process, so clerks will publish further details on those sessions in due course. I hope that all that information helps to clarify some of the queries around the committee's agreed approach towards oral evidence sessions. We will now move on to our first agenda item, which is to continue to take evidence on the Gender Recognition Reform Scotland Bill, and I welcome our first panel to this morning's evidence session. I welcome Professor Sharon Cowan, Professor of Feminist and Queer Legal Studies at the University of Edinburgh School of Law, Naomi Cunningham, Barrister, Outer Temple Chambers and Chair of Sex Matters, and Karen Monaghan, QC Barrister, Matrix Chambers. I refer members to papers 1 and 2. I invite each of our witnesses to make short opening statements starting with Professor Cowan. Thank you to the committee for inviting me to give evidence to you today. I am the Professor of Feminist and Queer Legal Studies in the School of Law at the University of Edinburgh. My research focuses on three many areas of study—criminal law, particularly the area of sexual offences and violence against women, asylum and refugee law and policy, and LGBTQ rights, particularly those of trans people. I have been working on those issues for over 25 years. Most recently, I have worked on a project that asks trans people about their understanding and experiences of equality law in Scotland, Canada and the US. I have also worked alongside Scottish Trans in Scotland, and I am on the advisory board of the Scottish Just Law Centre, whom I think you have heard from in a previous session. Focusing particularly on the Scottish context, when I interviewed trans people in 2016 and 2017, it was striking to me how many of them said that they were proud to live in Scotland because it was leading the way on many issues concerning LGBTQ communities, including equality laws and hate crime laws, and that Scotland was, and I quote from one of my participants, the best place on the planet to be trans. However, as the committee has heard from many others already, it has been recognised that the current system of gender recognition introduced in 2004 is in many ways no longer fit for purpose, not least because of its outdated reliance on the diagnosis of gender dysphoria. Replacing the current process with one that reflects international human rights standards and standards of good practice, as outlined by the Scottish Human Rights Commission in its submission, is now an urgent matter, as Scotland lags behind other jurisdictions in affording legal rights of recognition to its transgender, and I might add non-binary residents. If the Scottish Government chooses to introduce a system of self declaration of gender, it will not be setting an international precedent. On the contrary, it will be following the lead of countries such as Argentina, Denmark, Malta and Norway, Ireland, Belgium, Colombia, Brazil, Portugal, Luxembourg and Pakistan, countries that have introduced such a system without any reported problems, and it will also be complying with the parliamentary assembly of the Council of Europe's call in 2015 to develop quick, transparent and accessible procedures based on self-determination. Rather than being an outlier, Scotland is at risk, as it was, with the gender recognition act in 2004 of being one of the last to reform its law in this area. I look forward to answering the committee's questions and helping Parliament to create a bill that reflects the dynamic and progressive community that we know Scotland is and can continue to be. It is a peculiarity of this debate that some, at least on both sides, maintain that the grant of GRC's gender recognition certificates does not affect the operation of the equality act, and in particular the single-sex exceptions in the gender equality act. My position is that, as a matter of law, it should not—whether or not someone has a gender recognition certificate—should make no difference to the operation of the single-sex exceptions in the equality act, but we cannot be sure of that. Anyway, in practice, it makes them more difficult to use. It is more difficult for organisations that seek to maintain single-sex services or spaces in practice to deal with individuals with gender recognition certificates. Where you are on this question depends in part on what you think the concept of sex means in the equality act. Some say that sex already means self-identified sex. If they are right, getting a gender recognition certificate does not change your sex for the purposes of the equality act because your sex for the purposes of the equality act is already whatever you say it is. I think that position is legally untenable. Some say that sex in the equality act means legal sex, that is biological sex, except when modified by a gender recognition certificate. If those people are right, a gender recognition certificate undoubtedly does change the legal analysis of the way that the single-sex exceptions operate, but in my view it is difficult to imagine real circumstances in which it would change the outcome of that analysis. It changes the route, but in my view it almost never will change the destination. The reason for that is that the single-sex exceptions in the equality act are justified or not justified as a matter of practical impact, not as a matter of certification. I want to make that concrete because I think that it is important to think about the consequences of proposed legislation in very concrete terms. If I as a woman look up while drying myself in the women's open plan changing room at swimming pool and meet the eye of a naked male person, my feelings are going to be some mixture of surprise, embarrassment, anger and fear. Whether or not that male person has a secret certificate in a drawer at home is not going to make any difference at all to that mix of feelings in me. Most of the exceptions are variations on that theme. They are conditioned by a recognition of the needs and feelings of the general user of single-sex spaces. It is bodies, not identities and not certificates that affect those needs and feelings. My own view, picking from those three possible interpretations of what sex means in the equality act, is that sex in the equality act simply means biological sex. The consequence of that is that nothing about the way the sex discrimination provisions work is affected by whether someone has a gender recognition certificate or not. For these purposes they remain a biological sex. We have yet to learn which of these three views is right. These are tangled and difficult questions on which reasonable people, even reasonable lawyers, can disagree. I believe that Karen and I disagree on this specific point to start with. I am sure Karen, I and Sharon probably have three different views on these questions. I have recently changed my mind on what legal sex in the equality act means. I was in the legal sex camp, that is, biological sex as modified by our gender recognition certificate until a few days ago, but I thought deeply about it and rereading the equality act and particularly the single-sex exception provisions with a view to their practical consequences has persuaded me that sex must mean biological sex. There are even more vex questions arising out of the bill about cross-border effects of Scottish gender recognition certificates. Questions like what is the legal status of a Scottish-born 16 or 17-year-old with a Scottish GRC who attends a school in England and how is the school supposed to manage those legal and practical problems? Finally, I want to point out that the law is not just about what courts ultimately decide that it means. It is also about what people think it means. Often, that is the most important thing in practice. You can have a folk understanding, if you like, of the law that operates in practice for years before anyone actually brings a test case about it and finds out that that is wrong. That is what affects what happens on the ground. If you enact amendments to the gender recognition act that change both the size and the profile of the group who can be granted gender recognition certificates, what you will do in practice is create a class of people of unknown size and unknown characteristics who have an expectation that because the law recognises them as the opposite sex, they are entitled to be treated as the opposite sex by everyone around them in all circumstances. When they learn that that is not the case, that that is a wholly unrealistic expectation, it is not going to happen, they are going to be disappointed and angry. So this change proposed, I am sure, with the very best of intentions, is capable of having consequences for the very people that it is intended to help that are in fact positively cruel. Thank you very much for inviting me just to say something about myself. I am a barrister practicing in the sphere of equality law and have been for just over 30 years. I would like to say something about the scheme of the equality act and say something about the impact in the changes anticipated by the bill so far as the act is concerned. Firstly, as to the meaning of the two key definitions or the two key concepts under the act, sex and gender reassignment, as to sex, sex under the act means biological sex and we know that for two reasons, in fact three reasons, firstly sex is defined as being a man or a woman, secondly man and woman is defined as being male or female as the case may be, male and female as a matter of dictionary definition are correspond to biological sex and thirdly case law indicates that sex under the equality act means biological sex, biological sex will ordinarily correspond to legal sex. The importance of that I'll come to in one moment so biological sex which ordinarily corresponds to legal sex, that's what sex means under the act. Concept of gender reassignment that is a characteristic characteristic of transsexual people and I use transsexual people only once because that's the language of the act I'll use trans here after but gender reassignment is a characteristic of trans people it's given a very wide meaning indeed for good reasons so it means a person who is proposing to undergo is undergoing or has undergone a process of reassigning their sex so one need not even have started the process of transitioning to be protected by the provisions addressing gender reassignment that's a very positive thing because it means a person who goes into work and says to their employer I'm proposing to undergo gender reassignment can't be dismissed or at least if they are they will have a claim of discrimination what it doesn't do is change a person's legal sex as to the single sex services which is one of the key areas of controversy that is a positive action measure it ensures that women and I'll use women here because that seems to be the area of controversy or females females can access spaces that they may otherwise be excluded from for reasons of privacy trauma and so on single sex services are those services targeted at only one legal sex a women's single sex service will be targeted at an open to only those who are legally female that means a trans woman without a GRC that attends a women only single sex service can be excluded because they are legally male not so if they have a GRC I'll come to if they're legally male there are exceptions to that where it would be indirect discrimination to do so that it would be a rule that disadvantages trans people but given the wide meaning given to the concept of gender reassignment that is by no means inevitable so if a trans woman without a GRC seeks to access a female only service service the starting point is they can be excluded because they are legally male where a person has a gender recognition certificate then as this committee knows they are to be treated for all relevant purposes as of the legal sex recorded on their gender recognition certificate if a trans woman with a GRC seeks to access a women only service they cannot be excluded because they are legally female unless their exclusion or a policy excluding trans women can be justified that requires a legitimate aim to be shown and that it be proportionate so if you don't have a GRC you can be lawfully excluded that's the starting point if you do have a GRC you can't be unless it's justified when parliament enacted the equality act in 2010 it would have had very much in mind that there were few trans women with gender recognition certificates talking about a cohort of about 300 a year and that there would have been an objective assessment by an independent panel as to an entitlement to a GRC so what this panel proposes forgive me what is proposed in the bill i beg your pardon excuse me what's proposed in the bill is that the cohort of people who are entitled to a gender recognition certificate and therefore can access women only spaces save where justified is very much larger and very much larger than we can assume parliament intended when it enacted the equality act those are my opening observations safe to say that the convention the european convention does not require a scheme of this sort and whether or not this bill is enacted the equality act model doesn't need to be changed it's just that this committee needs to be mindful of the impact of making the scheme more liberal i hope those observations of assistance thank you very much for that that's all useful all three contributions will now move to questions starting with Maggie Chapman please thanks very much Joe good morning to the panel thank you for joining us this morning and thank you for your opening statements and other information that some of you have provided i want to explore two areas firstly the case for change or the need for gender recognition reform at all and then questions around gender dysphoria diagnosis and the panel that has been associated with that process um Sharon if i could come to you first in your in your opening remarks you talked about the the shift in views that you've identified amongst the trans people you speak to um in the last five years about Scotland being a great place to live to not being the case and i'm wondering how how you see that as being linked to or otherwise not so much the the discussions around this bill and we know that they've already been to consultations but on on the need for change on the need for something something that is within the current g r a to be different yes thank you um so it's notable that the people that i spoke to in my research um we had conversations before this recent kind of more recent in the last five years moved towards change so um their reflections on on how it was to live in Scotland under the under the at that point in time the current equality regime and all of the other elements of law that affected trans people was more positive um i think partly for the reasons that you mentioned about the way that this conversation has has evolved but also because i think there is a there is now an acceptance that the need for a diagnosis of gender dysphoria is problematic and i know that the committee has heard from many people on that on that particular issue both from a health perspective um in terms of accessing even a diagnosis which can take years and delay the whole process of gender recognition but also in terms of the way that um people access healthcare according to their other individual needs that intersect with their gender identity with disability race religion living in a rural part of scotland rather than an urban part of scotland and so on um so that i think that's primarily the the move that has been seen across the international um terrain if you like through w u h o and w path and all of those international organizations that have made that move and i would say that's from my perspective and from working alongside scotland's trans that is the number one thing that trans people would say is difficult for them about the current gender recognition process there are other aspects too but that's primarily the problem that they face thanks thanks Sharon that's helpful and and that i mean you said in your opening statement that the the need for gender dysphoria diagnosis is viewed internationally as outdated now i suppose that links quite closely with the current process of having the the panel of medical experts that assesses information can you just give some comments from the trans people you've spoken to and and from your analysis of of of that process as appropriate or or otherwise well again having having worked with people in the community but also with organizations who deal directly from the front line with trans people um that that question is um is so the work of the gender recognition panel is not is not like another tribunal which when you can go in and actually sit and watch what the proceedings are which you can do with lots of their courtrooms and tribunals so the work of the gender recognition panel is i wouldn't say it was secret that sounds a bit insidious but it's it's private for lots of good reasons but that means it's difficult to assess how the decisions are being made so the information on which we assess how the decisions are being made are usually about the correspondence between the tribunal and the people who are applying for a gender recognition certificate and again from my understanding that correspondence is not always very helpful in terms of asking for more and more information in repeated attempts to gain intrusive bits of information about what kinds of medical interventions they've had and so on and that that process puts off potentially a large group of people from even applying for a gender recognition certificate in the first place. Thanks very much that's helpful Naomi can i come to you and ask a similar question around your views on the case for change if you view there is one. I know in your opening comments you talked about that larger group of people being potentially eligible what is your view on whether or not reform is necessary? Yes it seems to me that the two biggest most important changes that are proposed in the bill are the reduction in the age limit to 16, the reduction in the minimum age to 16 and self-identification, the removal of medical gatekeeping. Taking the second of those first, I don't think the case is made out for the change proposed. I think the removal of any sort of medical gatekeeping, the removal of a requirement for a diagnosis of gender dysphoria, opens the process up and the availability of a gender recognition certificate up to a group of unknown size and unknown characteristics. We simply don't know who will apply for gender recognition certificates if all they have to do is declare that they intend to live permanently in their desired sex and we don't know what the characteristics of that group will be. The Gender Recognition Act was originally passed to meet the needs of what was at the time perceived and repeatedly stated to be a tiny minority of individuals with the distressing condition of gender dysphoria, so severe it was assumed that they felt the need to take medical steps to modify their bodies to look as much as possible like the sex that they wished they were. Self-ID blows that wide open into a group of wholly unknown nature, but potentially including those who choose to cross-dress for erotic purposes. There is nothing in the proposed legislation that would prevent erotic cross-dressers from simply applying for a gender recognition certificate in order to make it easier for them to access single sex spaces. They may not mean any more harm than finding their satisfaction from being seen in public as women and treated in all respects as women, but nevertheless women are entitled to male free spaces when they are naked, vulnerable or asleep, when they are undressing. They are particularly entitled to have privacy from males whose desire to be seen as the opposite sex is for erotic purposes. I am particularly troubled by that. Firstly, in a lot of what we have heard, the assumption is always that it is trans women that we are talking about. I think that we must recognise that trans men exist too, and Sharon mentioned non-binary people in her opening remarks. However, I am interested in the question of gender dysphoria and medicalisation, given that the World Health Organization has reclassified it. Given that we know that there is increasing evidence that not all trans people experience gender dysphoria, can we retain a restriction that excludes trans people from getting a GRC? I want to put that question back to you, if I may. You say that not all trans people experience gender dysphoria, but if that is the case, I am not sure that I understand what you mean by a trans person. The evidence is increasingly clear. There is substantial published research from engagement directly with trans people. That is not always the case. In the same way, as I would not want to prescribe what being a woman has to be, you have to look a certain way, you have to dress a certain way, you have to act a certain way. That is sexism. I am not going to do that. I am not going to do that to trans people either. If you define a trans person simply as anybody who defines themselves as a trans person, you have a hopelessly circular definition. You cannot make any useful generalisations about the characteristics of that group. I would say that the consequences of gender recognition certificate are quite extreme. They make very substantial demands on the rest of society. They threaten those who know about the existence of the gender recognition certificate and the previous gender identity with criminal penalties for disclosure, those who know about it in an official capacity with criminal penalties for disclosure of that information. They at least open up questions about access to single sex spaces and services. They make quite a lot of demands on other people. It does not seem to me to be unreasonable to say that this is a serious and elaborate accommodation that may need to be made for some small number of people if they prove their need for it, but it should not just be given out to anyone who says, I'd like it please. I suppose that one of the questions particularly around the panel and that process of submitting evidence and requiring more evidence for proving that you are who you say you are, that's intrusive and surely trans people deserve privacy as well? Well, a lot of the point of the Gender Recognition Act is to give transsexuals as defined privacy provided they meet the qualifying conditions, but it is privacy with quite serious consequences. For example, it creates an opportunity for what we sex matters in our submission have referred to as identity laundering. It makes that quite easy. So, simply to say that anyone who asks for it without any sort of proof that they have the real need of it that the original Gender Recognition Act was passed to provide for seems to me to be radically rewiring the nature of the task that the Gender Recognition Act does. It was passed in response to Goodwin in the European Court of Human Rights and the recognition in that that there were people who had taken every possible step that medical science could provide them with to transition and they were in a difficult position because they looked, they might well pass, some of them might pass anyway, but anyway they'd taken difficult and painful and frightening steps to change their identity and the state should recognise that and should accommodate that by allowing them to marry and so on. So that original purpose is very clear and what this change to self-id threatens to do is blow that wide open to something completely different and make the act do something completely different, but before I want to finish on your question or before I finish on your question I do want to talk about age as well because that's the other very worrying respect. If I know somebody else wants to come in on age later on so I'll leave them to do that if that's okay. You asked the question so I'd like to finish my answer to it. The other particular difficulty with the proposed changes is the change that the reduction in the age limit to 16 and what I think you need to have very clearly in mind on that is what Hillary Cass has said about the serious intervention that social transition is and legal transition must be a step, it's a step even further than social transition. If you if you crystallise a child's legal identity as the opposite sex at the age of 16 or 17 how difficult will it be for that child as they mature and human brains I believe don't mature fully till about 25 how difficult will it be for that child to say actually I got it wrong. Well I know that there are my colleagues around the table who will who will come back on on certain points that that you've made in that. Karen can I come to you I know what you you said in your opening in your opening comments and opening remarks. I'm interested in your question or your thoughts on that medicalisation process whether you agree that medicalisation of gender dysphoria in that way is problematic and whether or not you see that shift or that shift away from requiring that diagnosis being necessary. I'm sort of somewhere between Sharon and Naomi. I recognise that the diagnosis gender dysphoria is increasingly one that both internationally and indeed domestically is challenged or perhaps not recognised so I understand that. I do have a concern however for the reasons I've given about the size of the group who might qualify for a gender recognition certificate if this bill's enacted. I do have a concern about the absence of any meaningful gatekeeping to use the word of Naomi, the description of Naomi. There's very little by way of checking whether or not a person meets a requirement or requirements that will satisfy a gender recognition certificate. You made the observation that we need to move away from the idea of gender stereotyping. If we don't have a medical diagnosis and I completely see the reasons why that's problematic but if we don't have a medical diagnosis what do we mean by living in the opposite gender? What does that mean? How does one tell whether somebody's living in the opposite gender? It concerns me about the absence of any objective assessment, any gatekeeping and it also concerns me for reasons of legal certainty. How do we know whether a person is meaningfully trans without any objective assessment? While I completely understand what Sharon says and I don't in any sense suggest that she's wrong and I completely accept that concern about a diagnosis of gender dysphoria it does worry me that there doesn't appear to be any objective threshold for determining whether or not a person ought to be entitled to a gender recognition certificate. I note the evidence that you gave in Westminster in February last year and you said very similar things. When you talk about gatekeeping and safeguards what kinds of things do you have in mind? That's the difficulty. At the moment we have gender dysphoria so everybody knows an assessment can be made, it may be controversial but there's a panel, there's no means here of testing either permanence besides self declaration, there could be a panel that makes some objective assessment, determines whether or not this is real permanence, determines whether or not there's a meaningful dysphoria even if it can't be characterised as a medical condition but some gatekeeping and as I say it's problematic as well for legal certainty. The model of the equality act, the model of the equality act, you don't need justification or the starting point forgive me you may need in certain circumstances but the model, the starting point is you don't need to justify the exclusion of a woman, I'll use woman because that seems to be the area of controversy, you don't need to justify the exclusion of a trans woman without a GRC from a women only services service because they're legally male but you do if they're legally female how does one determine whether or not a person is meaningfully legal legally female where all you have is self declaration you know what what does that mean how does one live as a woman and without any gatekeeping any objective assessment of permanence and some form of dysphoria how does one how does one how does one slot that in it's not the model as I say it's the slotting in of agenda recognition certificate without an objective assessment okay thank you I suppose there's no other identities that we may have as human beings that require gatekeeping in that way and I struggle in terms in terms of those currently recognised by the equality act not so not so nationality citizenship and there may be a requirement to show heritage if you have a let's say a service that's targeted at Irish travellers because of particular health difficulties in the health in the traveler community and they have to show some evidence to show and there are protections accordingly of course for that but I suppose the question around you know that the wider group and and what characteristics might be included in in in that wider group I think I think there are questions for me around why why that is of of the legal significance that two of you on the panel seem to be given that I appreciate we probably need to move on so I'll leave it there for now. Thank you thank you you're reading my mind. Thanks very much we do need to be cautious to times a good number of areas that members are wanting to cover but we did cover more there I think than we expected to so that's good thanks for that. Fulton MacGregor please. Thanks good morning to the panel thanks for your opening statements and responses so far. I'd like to ask questions around two areas I've been exploring with previous panels and that's the provision to live in the required gender for three months and secondly the three-month reflection period so that I could start with the former. I guess about what I've picked up from all previous panels so far as this actually seems to be an area and not quite a controversial bill this seems to be an area of broad agreement from what we've picked up so far although maybe not for exactly the same reasons but we are hearing even from those who support the bill that the to live in the required gender for three months could be seen as quite quite demeaning because it's it's lightly that the individual has been living that way for quite some time and for those perhaps who have got concerns about the bill I'll use that word rather than opposed to it you know there's concerns that the time period isn't isn't long enough and maybe relates back into some of the concerns that Naomi mentioned earlier about you know perhaps increasing the number of people more than the Scottish Government currently think so I'm wondering what what your views on that are happy to start with yourself Sharon what are your views on this and obviously one of the other things we've heard as well is from across the board as a concern about the use of the term acquired gender and what that might mean Sharon if you've got any views on this and then I'll just come to Naomi so unsurprisingly perhaps I am also skeptical about the need for a three month living in the acquired gender requirement for the very reasons that you have stated and that other witnesses to the committee have stated that that many trans people have been thinking about this not just for months at a time but years and in some cases decades and so the requirements live in the acquired gender for three months seems unnecessary in terms of delay to the process I mean there is a range of ways of approaching this international jurisdictions have taken different views on whether there should be a time delay in place or not some people have very similar requirements to the ones proposed in the bill other jurisdictions such as Malta is a 30 day registration administrative process that doesn't take very long again my experience with talking to and working with trans people is that they would see that as unnecessary and also delaying in an unhelpful way the process of registration so that would be my response to that question. Do you want me to address the acquired gender part of your question? I'll come to that. Sorry in terms of that. I'm not quite sure what the question is getting at. Are you asking is that a problematic term? Do I think that that's a problematic term? Is that what you're asking me? That's what we've been told by previous witnesses that there's worries about the data? In my view, this is my personal view. I can't speak for anyone else on this. I think it's a very odd phrase. I've always said that since the act was introduced in 2004, I've written about that. It's on record that I think the use of the word acquired is a very strange thing. It sort of makes it sound like something that you've either picked up out of the cupboard or that you somehow come across it. It's just landed in your lap or has come out of the back of a lorry or something. You've acquired a second-hand washing machine or something. It's a very odd phrase. I think the difficulty, and I'm sure that this is something that we might all agree about in this area, is that the language is really difficult. Trying to capture what we mean by all of those terms, sex, gender, acquired gender, woman, man, which in human experience is very complicated and dynamic into a statutory form for the purposes of law is nigh impossible. We have to do it because we want some standards and rules and norms to live by, but it's a very difficult process. I'm not comfortable with the phrase acquired gender, but we could have a tour session on what an alternative phrase might be. I think that my greater concern is about the absence of gatekeeping, as I've described. I can see the question, why three months after the application, what's the purpose of that. As Sharon said, the likelihood is, not in all cases, but the likelihood is that for some people they will have spent some time considering whether or not to apply for a gender recognition certificate at all. Why three months? Why not six months? Why not a year? Why not anything at all? My main concern is less about the delay, but more about the threshold for qualification at all, that is living in the gender to which one wants to transition or acquire. I too have problems with the language, perhaps different problems from that identified by Sharon. I think that the language adopted by the Equality Act is clear and certain. We know what sex means and, for the avoidance of doubt, it's defined, so there's no ambiguity about that. The difficulty is introducing the concept of gender, which generally refers, as you know, to social attributes, and then descending into the sorts of sex or gender stereotyping that your colleague referred to. How does one live in the gender that one wants to acquire? What does that mean without a medical assessment? As I say, I'm likely to reiterate that I see the concerns about a medical diagnosis, but it does concern me that there's no real test for determining gender and how one establishes that they're living in the gender to which they wish to assign, and particularly the concern about gatekeeping. I think that the Equality Act gets it right, but I have to say that the Gender Recognition Act, whether or not the bill is passed, uses language that's difficult and complex. I haven't got very much to add to that. I don't personally have any particular problem with the Expression Acquired Gender. I think, as Sharon suggests, you could spend a very long time trying to find a better, more acceptable expression or more acceptable to all parties expression without getting any further forward. We are talking about a transition from one legal status at least to another, so something that reflects that seems to make sense. For myself, I don't really understand what it is to live in the acquired gender. It's very hard to imagine what other than conformity to the stereotypes expected of the opposite sex that could mean, so I don't feel strongly about those provisions. I'm moving on to the second area, which is the three months reflection period. I'll do it the opposite way this time now, because I know that I'm going at the end there at a lot of the points that may have been covered, so I'll go the opposite way. Again, we've heard some concerns about the three months reflection period, and I wonder if you've got views on that. We've heard concerns probably from, again, a bit like the last one, from both sides of the argument, but probably more profoundly this time for different reasons. Now, have you got any views on the reflection period? Again, no strong views, except perhaps in the case of children, if the amendment to reduce the minimum age goes forward, then I think anything that gives children considering making such a fundamental change to their legal status, a little bit more pause for thought and a little bit more time to mature and consider all the ramifications of that has to be a good thing, but beyond that, I didn't think how much to say on that. I don't have any observations to make about that, except no doubt the committee will be wanting to consider the particular position of children, but for adults I don't have any observations to make about that. I mean, similarly to what I said before, I think it's an arbitrary number of months. We often make big decisions for ourselves that we're not asked to reflect on, some of them are sexual declarations like getting married. I, again, from talking with trans people working alongside trans people, I think the theme of the reflection period is not a very helpful framework. If you were really worried that this was a life-changing decision that people might want to reflect on and you wanted to stress that for some reason, then three months actually seems like a very short period of time. In the sense that most trans people, again, have thought about this for decades, years, months and long periods of time in advance, the three-month reflection period doesn't seem to be particularly helpful. I just commented to Naomi and Karen that the issue about age was something that we heard quite strongly from previous panels as well, but, like Maggie, I had mentioned earlier, I think that there are others who are going to explore that area, which is why I didn't have any follow-ups. Thank you all three for your answers, too. Thank you very much. It's just to really develop the questioning around the reducing the age from 18 to 16. It's just opening the discussion as to whether you believe that people of age 16 are mature enough to make these decisions. We've heard lots of examples. It's very polarised, as you know, following the committee evidence, but at 16 you can get married, you can join the army at 18, you can buy fireworks, have a tattoo, buy alcohol and all the rest of it, so it's very, very different settings within those two years. I'm really interested in—I think it was Karen that mentioned around the European Convention that doesn't require such a scheme. I'd like you to develop that point on whether it relates to the age difference. How does this sit with the specific safeguarding concerns that some people may have over this and also with the European Convention? Do you think that parental consent should be required and what are your views? I'll start with Naomi. So far as parental consent is concerned, I would say yes, parental consent should be required. In general, the people who know a child best and can be best trusted to keep that child's interests at the forefront of their minds will be the child's parents. So the default position should be parental consent. But that seems to me to be a very unfortunate and inadequate safeguard in itself against this invitation to children to make life changing decisions that they may subsequently regret or that may set them on a path to harm. A reduction in the age limit with parental consent doesn't seem to meet the need. There should not be a reduction in the age limit at all. This is not something that any child, anyone who is not yet an adult, should be able to do. I'm not sure I have much more to say than what I said in answer to my previous question about the importance of having in mind Hillary Cass's concerns about social transition. I would suggest that legal transition is social transition with a great deal more besides. It's going to feel, it's bound to feel to any child, like a very solemn, serious step. It's a permanent declaration of intent with legal effects. Children under the age of 18, as you've just said, can't get tattoos. This is a much more serious life changing step for a child to take than getting a tattoo. And yet, the adults around a child think it their duty to protect a child from making that sort of step, at least without parental consent. Cass review in a minute, but Karen, if you'd like to come in. In relation to age, I probably can't help you very much. Intuitively, I feel 16 years old is very young indeed, but it's been a very long time since I had a child and I'm not a children's expert, and so intuition wouldn't be a good enough reason or a good enough basis for me to make a contribution to a committee like this. I think it's, I would reserve that for somebody with the relevant expertise. As to article 8, which I think I'm more qualified to speak about, I hope so anyway, article 8 does require a system under which the state recognises a change in sex. So there must be a system. What it doesn't require is a particular system. So the European Court of Human Rights has said there's a margin of discretion as they describe it, so each state is entitled to determine what its own scheme might be. There must be a scheme, but it doesn't require a scheme like this, for example, or like that proposed. And it's perhaps an important context to note, and I think Naomi alluded to this, that all the cases so far under article 8, and indeed, as decided by the European Court of Justice in terms of EU law, have determined cases concerning transsexuals, as they've been described, that is people who've undergone a process of medical diagnosis and surgical transition, not suggesting for a moment that surgical transition ought to be required, and I'm not suggesting that. But it is of note that in those cases where the European Court says there must be a system of recognition, they've all been cases where there has been very significant physical change and medical oversight. Pick you up on that point. So does that mean that if a scheme, and we're calling it a scheme in your words, was insufficient or it was inadequate or it didn't, it had an absence of procedural safeguards, does that mean that it's infringing the escalate of the European Convention? It may be. So, for example, let's take an extreme example, if there was a scheme that said you must have intrusive medical intervention, surgery, plus you have to wait 10 years and then you have to pay £5,000, in my view, the European Court would inevitably say that is not a meaningful scheme because it precludes many people who can properly be described as trans, either under a medical diagnosis or some other objective threshold, and so wouldn't be a meaningful scheme. I'm reassured because I can see Sharon nodding away next to me, but that would be the position in my view. Sharon, do you want to come in on that? I understood your questions that lay differently, so I forgive me if I've misinterpreted it, but what I thought you were asking was if we were trying to introduce a scheme that didn't have safeguards to protect young people from transitioning it too early in age, would that contravene article 8 be what you were asking? I hope that Karen would agree with this because I think that you are closer to working with article 8 on a daily basis than I am, so that that wouldn't be how article 8 would work. It would be the opposite round, so if a child felt that they weren't getting access to proper treatment through a system that recognised their identity, they could make an article 8 claim. I agree with Karen that, at the moment, the way that the European Court of Human Rights has interpreted the need to have some system for recognition still allows for some margin of appreciation to the UK and other states because there is no broad consensus on what a model of gender recognition should look like, and there are lots of different models across Europe and the rest of the world. I would draw the committee's attention to the fact that that was also the case before the Gender Recognition Act 2004, when the UK was in the company of Ireland, Andorra and Albania as the only European nations who did not have a proper system of gender recognition. At that point in time, the European Court of Human Rights had also given the UK a margin of appreciation, but eventually they were such an outlier that they were said to be in breach of human rights law, and that was why we got the Gender Recognition Act in the first place. Although we have a margin of appreciation does Scotland want to kind of lag around at the minimal edge of the threshold, doing what's necessary in the minimalist way, or do we want to be a leader in trying to come up with a system that is reflective of all these international and national changes, but gender dysphoria, age and so on? If I can come to the age question that you asked, I also am not a specialist in this area. I know you've heard from the commissioner for children and young people, and various other people who are specialists in this area. I would draw the committee's attention to the Age of Legal Capacity Scotland Act 1991 that says that a young person aged 16 or over can consent to lots of things, including life changing medical treatment, not just a document that changes your sex or gender, but a life saving treatment such as a heart transplant or so on, which is a lot more serious than it had to be at the age of 18. I think that in terms of the committee's work, it's important that we understand the legal implications from the point of view of someone who has that specialist ability to comment on that. I don't expect you to be able to do that, but perhaps it's something that we should consider. Sharan accessing clinical treatment for life-saving treatment is maybe slightly different to accessing puberty blockers, so it's something that perhaps we should develop with somebody who is a specific case law expert. The issue is that this bill has nothing to do with puberty blockers. The bill that's before the committee doesn't say anything about puberty blockers. I understand that there's a disagreement and ongoing research and discussion about the place of puberty blockers in treatment for the trans people who want that sort of treatment, but that is not what the bill before is discussing. Can I just respond very briefly to something that Sharan said? I spoke about the need for a system under article 8, whatever that system might look like, and I think that Sharan, if I understood her correctly, was saying that that wouldn't address a situation where a child had received recognition. In other words, would that engage article 8? In my view, there might be circumstances where granting a gender recognition certificate to a child with all the consequences that might flow might violate article 8 because it intrudes upon their sense of identity, their personality, and may have longer-term consequences like which school they're going to, how they identify and so on. It may do without proper procedural safeguards in any event, and again, I can see Sharan nodding, so I'm way assured by that. I was just thinking that not so much that I was agreeing entirely with your point, but I can see the argument that you're making. Just two very short additional points. On the CAS review, Dr Hillary Cass has been commissioned to undertake a thorough review of the treatment of gender dysphoria in children, and this isn't just about medical treatment in the shape of puberty blot because she is also considering, and she's already mentioned in her interim report, the consequences of social transition and the fact that that's a serious intervention. The main thing, I would say, in relation to CAS, is wait. She hasn't finished her job yet, she needs to be able to finish her job, we need to understand the implications of that for children's needs and the treatment of children presenting with gender dysphoria before any such radical change ought to be made allowing children to change their legal sex. The other point is just to endorse very strongly what you've said about the importance of this committee hearing from a lawyer specialising in child protection because there will be issues that need to be explored that none of us here have the specific expertise for. Can I just pick up on something that you said in your opening statement there about affecting the legal status of a Scottish-born 16-year-old accessing services in England? What did you mean by that? Was that specifically on education? Not necessarily specifically on education. One of the areas of greatest difficulty to my mind in this bill is the whole question of cross-border effects. Those who are entitled to apply are those whose birth was registered in Scotland, so Scottish-born children or resident in Scotland, which I don't think we know exactly what means for how long you have to be resident before you're entitled to apply, but it's certainly going to be the case if this goes through that there will be children who have a Scottish GRC but are living resident in England, I'm going to English school or England and Wales or the rest of the UK, and are going to schools and need to be accommodated and dealt with and they have a legal status whose full consequences I certainly simply don't understand and that's something I suggest needs to be very carefully bottomed out. Are Scottish GRCs portable? Will they have full effect in the rest of the UK? If they don't, what are the consequences of that? Is this an alternative route or can you have both a rest of the UK GRC and a Scottish GRC in parallel? If Scottish GRCs are to have effect in the rest of the UK does that require action on the part of the Westminster Government? Do you require action under section 4 of the Scotland Act? All of those are difficult questions and they don't seem to have been bottomed out and I suggest they very urgently need to be. For fairness, I think it's important that I just ask the other witnesses regarding the cast review. I just wondered whether you had any opinion about the interim cast review and whether you believe that the GRR should be paused to reflect the publication. Karen? I would say absolutely. I mean this is a major piece of work looking at the impact on children and I think it would be very unfortunate if the committee or the bill were enacted without the benefit of the outcome of the final report. My understanding is that there has already been a children's rights and welfare impact assessment of the bills, is that correct? Looking at other jurisdictions where this has been done, there hasn't shown any negative impact on young people. I'm not going to refer to 16-year-olds as a child and this is a young person of age 16 or over having impacted on any negative effects in other jurisdictions that have done this. I think that there is already evidence that the committee can consider in that respect. A couple of points from that that I want to just pick up on. First of all, we did invite Dr Cass. She's declined but has referenced us to her interim report. I think it's worth noting that Dr Cass's remit was specifically in relation to NHS England, so I think that that's just there, but obviously anyone can look at her report. I think that the other point that was made by Rachel and Naomi in relation to specialist evidence around children, I think that no one would have talked about lawyers, but I think that for anyone watching, I would suggest that they look back at our evidence with the Children and Young People's Commissioner. Obviously, he is not a lawyer, but I guess he had access to lawyers in terms of answering the committee's questions at that point. Sorry, but I wasn't a member of the committee at that point in time. I think it's important to get that in public records. I think that that's why I'm saying that anyone who wants to look at that can look back on to the Scottish Parliament website and can see the evidence that was given in our official report as well. Pam Duncan-Glancy. Thank you, convener, and good morning to the panel. Thank you for the questions that you've answered so far and also for setting out your opening statements, some pretty clear bits of advice, including on the legal definitions of sex and gender reassignment, which I found particularly helpful. Thank you for that. Thank you also for the evidence that you've submitted in advance, which has also been very useful. I want to explore a little bit more about the impact of agenda recognition certificate and single sex basis. I know that we've spent quite a bit of time talking about the effect of agenda recognition certificate in that regard, so we've spoke about your point around the effect of it and what it means for the exclusion of trans people from single sex basis. You were quite clear about that. As far as I can understand, what appears to be the kind of issue is around the cohort of people who will be able to access that regardless of the effect of it, if that makes sense. There's a legal effect that doesn't appear to change as a result of this act, but that more people will have access to that legal route is my understanding of what you've said. If I've misunderstood it, please do connect me. Could you tell us a bit about who you think the cohort of people will be? We have heard some evidence so far that it's unlikely to be a group of new trans people, but it is likely to be an existing group of trans people who haven't yet considered accessing agenda recognition certificate because of the troubles with accessing one. Could you tell us a little bit about who you think that cohort will be? My understanding from the evidence that we've had is that those people who do not have a gender recognition certificate are currently accessing single sex spaces. Women's age and others have given evidence on how they operate those. Some of the people that we're talking about here don't have gender dysphoria, but we still would like legal recognition of their sex. Could you tell us a bit about the cohort of people and who you think they are and how you think their rights to accessing single sex spaces will be changed? Is that at risk to me first? Yeah, I'll probably all three of you, but feel free to go first. My view is a bit complicated on what the legal effect is. My view ultimately is that the sex that dates me in the Equality Act means biological sex, so a gender recognition certificate doesn't change it. That means that in formal terms, if I'm right and we just don't know whether or not I'm right on this, but if I'm right, in formal terms, the grant of a gender recognition certificate will make no difference at all to legal entitlement. I don't think I can talk usefully about legal entitlement to access single sex spaces. It's much more likely to be the other way around legal ability of those running them to exclude. My view is that if a space or service is within the single sex exceptions in the Equality Act, because sex in the Equality Act means biological sex, if you have permission to exclude all male people, that means all male people, including those who self-identify as women, and including those who have a gender recognition certificate defining them as female. That's not the end of the answer by any means, and that's the cause of my particular caution and my fear that this proposed change may operate in quite a cruel way to the group that it's intending to help, because it will create an expectation. It's already the case that there is a widespread belief that, because people with a protected characteristic of gender reassignment are entitled not to suffer discrimination on that ground, it follows that they must be entitled to access all single sex spaces provided for the opposite sex, or it follows that they must be entitled to be treated for all purposes as if they were the opposite sex, and of course that's not the case. The entitlement not to suffer discrimination on grounds of gender reassignment means, for example, that you can't be excluded from the men's toilets, if you're a trans-identifying male, because you can't be told no, you can't come in here because you're trans, but what you can be told is no, you can't come into this female-only space because you're not female, even if you feel female, even if you identify as female, even if you have a gender recognition certificate that says you're female, still this is a female-only space, but that's sex discrimination, that's not gender reassignment discrimination, so the protection from gender reassignment discrimination quite importantly doesn't provide protection from exclusion from services and spaces provided for the opposite sex, but the problem that we have is that it's very widely believed that it does, and providing gender recognition certificates to a much wider group, and there's a wide belief that if you're trans at all you're entitled to use spaces and services provided for the opposite sex, and there's probably an even wider belief that if you have a gender recognition certificate that entitlement is even stronger, the world has to treat you as if you were the sex you wish you were, and I think that's legally wrong, but that expectation is going to be created, and then that expectation, the best of my belief, is going to be disappointed when we find that there will be litigation, there will be bitterly fought litigation on these questions, and my expectation is that the final outcome of that litigation will be that all those people who were given a gender recognition certificate that much wider cohort, who had something that they very much wanted, they thought promised to them, will ultimately be disappointed of it, and that's a worry. Can I just press you on that point? Do you think that people access and agenda recognition certificates are doing it with the main purpose of access in single sex spaces, because if that's the case then what you're saying may indeed be the case, I'm not sure if that bears out an international evidence but I could see how it would be the case, but a number of trans people have said that it isn't about their access to single sex spaces. Some have even said that they recognise that that could be difficult in some circumstances, but in fact it's about being recognised in the gender that they live when they die, or when they go for a job, or when they go to university. Do you have evidence to suggest that people are accessing it for those other purposes? I don't think we have any evidence at all, we simply don't know, we already don't really know what people are accessing gender recognition certificates form, we certainly have very little way of guessing at the motivations and no doubt there will be a wide range of motivations and a wide range of backgrounds and background circumstances behind people's access to new self-id, gender recognition certificates. I think that that's one of the most troubling things about this bill, that it creates a much greater level of uncertainty both as to the nature of the new class of gender recognition certificate holders, we simply don't know who they're going to be, and also the size of it, we don't know how many they're going to be. So do you therefore think that the people who, various different bits of research have identified as trans, but don't yet have a GRC? Do you think that there are missing people in that? And if you do, who are those people that you think will come forward for a gender recognition certificate that are not yet known to any services or organisations? I don't see how we know the answer to that question. If you're saying you can have a gender recognition certificate because you say on the basis of self-identification, you make it very easy for anyone who wants one for any purpose, but I would be very surprised if that purpose wasn't sometimes identity laundering. That's a particular worry. You yourself have called the process I think you said solemn and serious. So do you think that if it is a solemn and serious process which is to access a gender recognition certificate that people will do that, use it for those purposes? Yes, I do. I think some people have very strong reasons for wanting to launder their identities. There are criminals as well as good, well-meaning people in the world and we need to have laws that are robust to people with bad intentions as well as we can't make law on the assumption that everyone who might possibly use this law is going to do so with the best of intentions. They have to be robust to bad intentions too and I think there are a range of bad intentions that could be facilitated by those changes. Do you think that those bad actors and I agree that there will be some people who want to harm women and do you think that they feel that they need a gender recognition certificate to do it? No. The problem with making gender recognitions much easier to obtain is it will create a greater sense of entitlement, a larger class of people who have this secret certificate in their filing cabinets that nobody dares ask them about because of the potential criminal penalties for disclosing what they know. I am sorry, I have lost track of the question. It was in recognition of the fact that there will be people who seek to harm women and there have been for forever and we think that they will need a gender recognition certificate to do so. What we are seeing is a steady erosion of the ability to protect single sex spaces on the basis that they are simply obviously single sex. If you say anyone who identifies as a woman can have a gender recognition certificate and give the impression and the impression will be widely given that especially anyone with a gender recognition certificate is entitled to access any single sex service and nobody can deny them that, then you create a situation in which it is impossible ever to challenge someone who would not be there. You see someone who looks like a man and you don't know whether he identifies as a woman, you don't know whether he might have a gender recognition certificate. He may be dressed as a woman but you don't know whether he's an erotic cross dresser, a trans person with gender dysphoria but no gender recognition certificate, somebody fully medically transitioned with a gender recognition certificate. You don't know what his status is but you ought to be able to say, these are my boundaries, I've consented to take my clothes off or whatever it is in this space that I've been told is a women only space and it's the impact on me that matters, it's the impact on the general user of that space that matters. This actually takes me back to a point about indirect discrimination and justification. It has been suggested that excluding males from women only spaces across the board might amount to indirect discrimination on grounds of gender reassignment and in purely numerical terms that's highly possible, maybe probable. But in terms of justification, once you think about the proportionality of the fact that as soon as you've admitted one male person to a space where women want to take their clothes off to take an example, you have spoiled it for all the women, you have made it, it is no longer a women only space, it's not single sex, it's mixed. So when you're looking at the proportionality, the justification of maintaining single sex spaces, it seems to me pretty much inevitable that you're always going to come to the same conclusion. As soon as you admit one man or one male person identifying as female, it is no longer a single sex space, it's a mixed space and it's lost all its purpose. No woman can be confident that it's a single sex space so justification is always going to be in place. Sorry, I may have drifted a little from your question but I think I answered it at the start. Thank you and that's no problem at all, it seems to be the case with a lot of the discussion on this issue, to be honest. Karen, do you have anything further to add? If I can just clarify a couple of things and then talk about the cohort, if I may, and I do this because of your observation about women's aid, as to the provisions in relation to single sex services, first of all they're permissive, so nobody has to set up a single sex service. In other words, if you're a counselling service, let's say sexual violence counselling service, you don't have to become a single sex plainly. Secondly, where you are a single sex service, the starting point is that those without a GRC can be excluded if they're not of the sex that the service is serving, so trans woman without a GRC can be excluded from a female only service. Just for clarity there may be circumstances where justification is required but it's complex and the key issue is the starting point is you can be excluded. Permissive don't have to be excluded, so women's aid can say we want to be a single sex service but we want to be trans inclusive, that's permissible. But similarly a service may say we're a single sex service and we want to and we lawfully can exclude trans women without a GRC, so it's permissive. Secondly, as to the cohort, and I've got one small point in addition to this, the answer is we don't know who the cohort will be because what we know now is there are a small number, 300 or so a year, of people who obtain a GRC. We don't know who the cohort or the size of the cohort, if the bill is enacted, but we can assume it's much larger because one of the complaints about the present system is that people can't access a GRC where they want one, so we can assume it's much larger who they will be. We don't know because there's no gatekeeping, no threshold, no medical intervention or objective assessment. Living as a woman, as I've already said, gives rise to the sorts of stereotyping we've spoken about, what does living as a woman mean? I don't know. Fourthly, I would just like to say, and this is really in case I forget it, so slightly off point, but if I may, we must also not lose track of women from minority communities who may be especially impacted by liberal rules in relation to GRCs, and they are often the most vulnerable women who access services, sometimes gatekeep, if you like, through other services, health and so on. I would invite the committee to be extremely mindful of that. I'd like to come back in and second that. Bear in mind that standards of modesty for different communities are widely varying. Sorry, I'm just conscious of time and I'm keen to hear from you. Karen, can I just ask you one other question about that? We've heard from people who consider who are trans but who don't have gender dysphoria, so what could we do to allow them to access a gender recognition certificate, which is incredibly important for them? That's what I was indicating at the beginning, if we accept that gender dysphoria isn't really a medical condition and ought not to be recognised as such. I've heard Sharon about that. How do we identify who's trans? That is problematic. Living as a woman cannot be the threshold. I don't know what that means. Do I live as a woman? I wear trousers, I've got short hair, I might be said to be gender non-conforming in a broad sense, so I don't know what that means. I think that the committee, if I may say so with respect, needs to be careful about setting an objective standard, which is one that is capable of being determined within a legal scheme. There has to be a degree of legal certainty. If the committee is moving away from gender dysphoria, I would invite the committee to consider how we know what a trans person is and how they meet the threshold. Is there an example of international law that you could suggest to us? No, but Sharon may be able to. Within the context of the Equality Act, which is my area of expertise, I would be very concerned if there weren't an objective threshold, which means that there would be a wide cohort of uncertain people accessing women's spaces that may disadvantage some of the most vulnerable women, victims of sexual violence, for example, and women from minority groups. I'm sorry, just coming in very shortly on that. Can you be mindful of time? I'm sorry. I think that I was wanting to ask Sharon now. Thank you. Sorry, Naomi. Do you have anything to add on this particular point? There's so much in your question to talk about. I'll try to be brief and to the point. Who is the cohort of people who might want to access a GRC who is currently not doing so? I think that it's true to say that we don't know exactly, but we can look to other jurisdictions that have introduced those systems of more accessible GRC certificates for people. What we can say about that is that there might be an initial uptick in those going forward with the GRC process because it is going to be easy for people and the current system does put people off as we know, as you've heard from other people, but there's no evidence from other jurisdictions that there's a sudden mad rush of thousands of people to get GRCs. Although we don't know, and I can't say that for sure, we do have some evidence from other jurisdictions that would point in that direction. I don't want to get into this in a lot of detail because it would take a long time and it's a super complex area of law, but my understanding of the quality legislation actually differs quite markedly from the understandings that have already been presented to you today. My understanding is that it doesn't matter whether you have a GRC or not, you can still be excluded from a single sex space because the Equality Act itself does not say in the act that you either must have or must not have a GRC in order to be excluded. The current law already allows a single sex space or sex secretary to space to exclude somebody whether or not they have a GRC if they meet the correct legal threshold, which I'm sure you have heard of as a proportionate legitimate aim and so on. In terms of whether or not people can still be excluded after this proposed system, if it were introduced, that part of the law remains unchanged. People could still be excluded whether or not they had a GRC. If there are more people with GRCs, there are more people who could be excluded, but the bar for exclusion is high. What does it mean to live as a woman? I often spend an entire semester talking to my students about what it means to live as a woman. That is an incredibly complicated question. I am, as much as anybody, a suspicious syskeptical of gender stereotypes, but it cannot simply just be the reproductive bits that you have. Feminists for decades have been arguing that we should not reduce what it means to be a woman to our reproductive organs, to our bodily autonomy and so on. Therefore, an understanding of what it means to live as a woman is complex, is nuanced, is maybe not something that we can capture in a bill or an act, but from my perspective, from the perspective of much feminist research, it cannot simply be just biological elements. That's my view. You want to come back in just very briefly because we've got two more folk and they might want to cover some of this area, so don't take it too wide because the other folk are one to cover areas. The point that I wanted to put in at this point is that specific sensitivities to women who've suffered sexual violence are, of course, necessary, but that must not be confined to services specifically for those women. The problem is that we don't know—nobody knows—at the swimming pool, at the gym, at the public toilets, at the library, wherever, you don't know which women using those services have suffered sexual violence, which women carry trauma from male violence, and they need to be able to use those services freely without making a declaration about their past. You should, as a traumatised woman who has suffered sexual violence, be able to use the loo at the library, for example, without having those traumas triggered. I think that that's a very important point to bear in mind. The needs of sexual abuse survivors aren't confined to specific services for those groups. I don't have any disagreement with that. I think that's right that we don't know how people experience sexual abuse in the community more generally, and that needs to be taken into account. I just wanted to point the committee in the direction of a piece of research that was done at the University of California on testing whether or not opening up laws to protect trans people have an impact on the rates of reported violence in toilets and changing rooms and bathrooms and so on. The first piece of research to do that was found that the passage of non-discrimination law is not related to the number of frequency of criminal incidents in public spaces, and it did a massive piece of research. The reports of violations in bathrooms and locker rooms are exceedingly rare. As a feminist researcher who works in sexual violence, I know that a lot of violence goes unreported. The study is only looking at reported violence, but it still indicates that there is no connection between opening up anti-discrimination laws and reports of violence in those kinds of spaces. Good morning, panel, and thank you for your opening statements and the information that you have provided. I certainly have found it very knowledgeable, especially if you spoke to Abercaron about breaking it down, where a GRC certificate applies and where it doesn't, and obviously gender and sex. My question follows on from what my colleague Pams just said. It's in relation to the bill because we've heard many concerns of people that are opposed to the bill in relation to the self-excluding using those single sex services. It's mostly in relation to—I know that you've spoke quite a bit about that—the female representation on public boards and in sport. Obviously, you've heard about sport. The fact is that it is an unfair or fair playing field. Also, in relation to what you've touched on, Karen, and Naomi, you've touched on the minority groups and how it will impact on women of faith. You've discussed that, and there's a little bit more detail on that. What do you see the solution, especially in relation to the sport question and the women of faith, and how we must be mindful not to exclude anybody out there and make sure that, with the bill, they don't feel excluded? First of all, there is an exclusion in relation to sport already that allows for women with a gender recognition certificate, so trans women with or without a gender recognition certificate to be excluded or to be not allowed to participate in sports in women's teams, for example. The reason for that is, of course, bodily strength and so on. There is an exception in place that doesn't depend upon whether or not a trans woman has a GRC. They can be excluded from competitive sports where their body means that it would be unfair, so running, for example. There is that exception. It's a different exception, and it applies whether or not a person has a GRC. As to the representation, for example, it seems to me to be very important, along with equal pay, which I don't know whether you've spoken about, but in terms of representation, there are positive action measures in the Equality Act which allow, for example, positive action to address a lack of participation or the overcoming of disadvantage. The more likely a person has a GRC, the more likely they will be there for or inevitably, the more likely there will be a larger cohort of trans women. I only use trans women because that's the controversy, but, of course, I mean it the other way. There will be a larger cohort of people who are able to identify as females and take advantage of positive action measures, including those who have been directed at females because of historic disadvantage. Now, trans women may well experience historic disadvantage as well, but for different reasons. For females, those biological women who've lived as women for the whole of their lives, gone through the education system as girls, experienced the disadvantage that girls often experience, such as being rooted into different courses, non-sciences and so on. There may be positive action measures directed at them, but trans women with GRCs will become entitled because they will fall within the cohort of women to whom eventually those provisions are addressed, even though they may not be the disadvantaged group. Similarly, if I may just say equal pay because that hasn't been, and I'll just do it in two minutes, I see the time, but I don't think it's been mentioned. Of course, once you have a person with a gender recognition certificate, trans woman again, using that example, they will be treated as female for the purposes of determining whether or not there are disparities in pay. So, if you have three women and a trans woman who appear to have lower pay than a man, if that trans woman has gone through their career as a male and so has comparable pay to the male, it may obscure inequality in pay between, I'm not sure I've expressed that very well, but I hope you understand what I mean. If you're looking at average pay, if you have a trans woman who has gone through their career as a male, their pay will be higher and may conceal disparities between men and women pay, particularly when we've got the sorts of, I mean, you've had it in Scotland, you know, local authority pay disparities and so on. So that's an issue the committee should just be alive to in my observation and perhaps think about that. Can I just look back on the minority groups? Obviously that's the other area. Yes, as I've said, where a trans woman has a gender recognition certificate, then they can't be excluded from a female space unless that female space is able to meet the threshold of justification. It might be a small organisation, for example. If you've got a small sexual advice, sorry, a small sexual counselling service, for example, or a swimming facility that's used commonly by minority women, they may not be able to use that facility if trans women are admitted. Now, there's no point saying, well, they ought not to think that or that ought not to happen. That is the reality and often they're the most marginalised communities, certainly in some areas, the most marginalised and they may be excluded from certain services if trans women are permitted access. Now, as I've said, trans women can be excluded even with a GRC, where there's justification, but there's a threshold that has to be met. Great care must be taken, it seems to me, on ensuring that all members of the community, all women, are not excluded from services. Again, I would invite the committee to think about that. Can you just touch a little bit on the women of faith here, the fact that if it's a religion or certain things that you've probably heard in past committee meetings, we've discussed this, that how do we feel them not feeling excluded whether it's in a swimming changing room, are they going backwards? The fact that we have heard in a private session, if I'm not allowed to say this, that it's just a little bit about the fact that people shopping online and going into changing rooms and then they decide that, hold on, we just shop online so we don't want to go out to a changing room in case somebody else is there. So, it's just on that, how do we make sure that everybody's included not excluded there, Naomi, just a little bit on that? I think this is a huge problem and insufficiently examined so far, that if you make all single sex spaces and services in effect mixed spaces, mixed spaces from the point of view of women with particular beliefs and women from particular faith groups, then you are liable to create a situation where women in those groups are effectively excluded from all kinds of aspects of public life, which may be necessary to their inclusion in society as full members of a democracy, they may be denied access to the library because they can't go far enough from home without using the loan, they can't be confident that the toilet is a single sex space, they may not use the gym which is important to their health because they've attended a women-only swimming session without which they might not feel comfortable or might even not have permission of their families to attend the swimming pool. They find a trans-identifying male in that swimming session and they leave and they never come back and we won't necessarily know about these effects, we'll just create a gradual chilling effect where women from certain sections of society simply self-exclude and possibly the worst of those is self-exclusion from rape crisis and domestic violence services because that really is piling disadvantage on disadvantage if an abused or sexually traumatised woman can't access the services that she needs because she doesn't have the comfort of knowing that when they say single sex they mean single sex and they mean what she means by single sex then she may be excluded and that may be whole populations and I think we need to think about the proportions here and that takes me on to some of the positive action measures in which a similar point arises. It makes sense to have positive action to seek to equalise the representation of men and women on various public in various contexts and public functions. So for example the provisions about single sex short lists that makes sense because the population is divided into two roughly equal halves men and women you couldn't have any comparable provision to ensure proportionate representation of trans people in those sorts of circumstances it would make no sense because the numbers are far too small so and we notice that you can notice that from the fact that we don't have we only have those provisions in relation to men and women so if you allow individuals who have self identified as women to take the places that have been reserved for women on short lists or or or what public boards or what have you then you reduce the opportunities for women and you undermine the very purpose for which those provisions were made and you do so in a way that I would suggest is fundamentally unfair thank you I was just going to ask Sharon yeah if you do that first then I know Pam Duncan-Glancy wants to come in for a small point and then Rachel we've heard quite a lot from Naomi and Karen just is there a solution to this is there something that we can have this happy medium that we don't exclude anybody and that we make sure everybody's included I think it's a really complex question I think that intersecting categories of human experience like race religion disability nationality citizenship they're all really important issues that we need to pay attention to how they work together to compound different forms of discrimination and so on and trying to finally balance those I think is often best left to the people who provide those services so for example I would want to defer to someone like Shakti women's aid to have I don't know if you've heard from them but to services like that who provide services for women of colour or particular religions but some of whom actually will be trans themselves also and some of whom are Indian Muslim and trans and so how to deal with these really important cultural sensitive issues I think is probably something to talk to those kinds of organisations who manage those kinds of issues all the time that movement what I would say. We have heard privately from one of those organisations and they have talked about it was just more on the religious side that when they actually come outside not the service but when they use places that how do we make sure everybody's included I think that maybe using the guidance from those organisations in those contexts could be broadened out more generally we could learn from those and a more public environment through you know local government and so on so I don't think the kinds of solutions that they come up with should be confined only to the women's sector there there are lessons that we could learn from more generally in society I think. Thank you Sharon so it's very important that we hear from these organisations to make sure this bill you know includes everybody and represents everybody in Scotland. Could I just come back on one other thing that came up there it was just about the proportion representation of smaller groups and I just wanted to say that I understand all the arguments for you know all women short lists or 50 50 and so on I think it's problematic from my perspective to say that it's not possible to do proportionate representation of smaller groups because otherwise we wouldn't have we wouldn't be able to think about race or religion or other protected characteristics where people are represented in a much smaller number of percentage of the community we wouldn't be able to think about imaginative ways of protecting them if we didn't think more broadly about proportionally trying to represent smaller groups that was on the only point I wanted to make. I just wanted to reflect very briefly Naomi on your comments about women worrying about whether or not there's going to be a toilet that they can access safely and I just want to say on the record that as a disabled woman I have I experienced that as I'm sure everyone around here will know it is a horrible thing to worry about whether you're going to be able to access a toilet or not so we need to get this right but I can only also imagine that trans women will go through and trans men will go through a similar experience about when they leave the house and whether they're going to be able to access a toilet or a change of name. Would you agree that perhaps part of the solution to this is that we have inclusive and private spaces? Absolutely yes for toilet provision it really shouldn't be very hard either there need to be fully private facilities for everyone in which case sex simply doesn't rise or else there needs to be men's and women's and single sex sorry unisex fully private for anyone who isn't comfortable using the men's or the women's so once you've got that third space or else full privacy the problem is solved. It is the third space but yeah I take the point about the privacy thank you. Okay thanks and Rachel. It's just I'm noticing that obviously that and I respect the differences that Naomi and Sharon have and Karen somewhere in the middle of but I just wanted to ask on the legislative competence of expanding the legal definition of a woman I mean it's not we can't do that can we in terms of the examples that you're giving in terms of gender representation so on Sharon's point how you use the term reduced biological sex I don't really understand how that can be interpreted in law. Can I perhaps usefully try to answer that? I think the case that you're referring to is the judicial review of the gender representation. You're using the gender representation example yes so I think the court was really clear in that case and saying it would have been open to the Scottish Government to protect trans people by making provision for them to be represented on public boards but it would have had to have been done under the heading of gender reassignment not under the heading of sex so that's what I'm saying is we can protect people whether it's on the basis of religion or race or gender reassignment even if they're small populations we can we can think of imaginative ways to protect them and involve them in public life and all that court case was saying was not that we can't do that but the way that the Government had tried to do it was wrong because it had gone beyond its legislative competence in changing the definition of women. I don't think I have a concluded view about whether what's proposed is within the Scottish Parliament's legislative competence I think that's an extraordinarily difficult and complicated question but I certainly think it's far from clear that the answer is yes. The worry is that in legislating in the way proposed you will create a situation you will make law that's open to challenge either from Westminster or from by way of third party challenge and that will be bad for certainty and undesirable in all kinds of ways so it's certainly not clear. I meant clarification but it ended up growing arms and legs and I think we could go on. Quite a lot of my questions we've gone through in great detail so I'll try to avoid retreading but now only the comments around self-id and concerns that that could mean expanding the group of people who would be able to obtain a GRC. Previous witnesses I'm aware have come to this committee and described the current process as discriminatory so if there are barriers to people who don't have a lot of money behind them or who live in somewhere that doesn't have easy access to gender identity services is it not incumbent upon us to do exactly that and expand the group of people who are able to obtain a GRC? Well so far as money is concerned I think I'm right in recalling that the fee has now come down to £5 anyway and I think even that fee can be remitted on proof of hardship but yes I'm not sure I remember that exactly right so I didn't think financial hardship is is likely to be a significant concern. I suppose my answer to that is simply that there need to be clear criteria. We need to know what what the conditions are that justify the grant of agenda recognition is difficult because it has these quite far-reaching effects and consequences and if it is simply in effect available on request I think that is capable of having some very damaging effects so I don't think it's about discriminating against any particular group it's just about it's about gatekeeping in the in the best sense this you know before you provide benefits to people before you people need to show that they need them or show that they're entitled to them and this this particular sort of benefit a state recognition of a new official sex legal sex is something that it it's reasonable to expect some quite serious proof of entitlement to so yes that that's true of many things I don't think it's I don't think it's peculiar to to trans people I think I think certainly at the moment just to clarify on the financial side the current you know gatekeeping includes the need to access these services which can be financially prohibitive and then going and seeking the medical proof of of what you've been through can also have fees associated with it so I think that there are a lot of recognised financial sides to to going through the process as it currently exists besides you know the actual applying for and paying the the £5 so that that's more what I was referring to and if if trans people are coming forward and saying that these barriers do exist for them and I invite Karen to to respond to this as well do we not have a duty to to take those barriers down well I mean this is moving a bit beyond my my expertise but my understanding is that the Scottish NHS is still the envy of those of us south of the border it shouldn't involve expense to access a diagnosis of gender dysphoria um and yes it's tempting to say it would be nice to remove barriers for people having whatever they want but if whatever they want has consequences for other people which I think you've heard agenda recognition certificate can have um then we can't simply remove all barriers we need to we need to know that people are entitled just just really to repeat what I've already said I completely accept there are difficulties with the gra as it presently is drafted I also think there are difficulties with the concept of a diagnosis of gender dysphoria so I'm not suggesting there isn't room for improvement at all what concerns me is the absence of any objective assessment of who might be trans and who therefore might be entitled to agenda recognition certificate and no gatekeeping as we've described and the impact on the equality act and the cohort of people who might be able to access single sex services and if you sweep away the diagnosis a medical diagnosis it's very difficult to see what you're left with what else could it be what what is it to be trans I suppose I was going to move on to that just just slightly because there have been quite a few comments around you know the need for a standard to be met or for some proof to to be standardised um the experience of trans people though is as diverse as cisgender people so is it possible while also you know respecting trans people's right for privacy and dignity to prescribe an experience that they must go through or must prove in order to have their identity recognised by the state well this takes me back to my difficulty with what does trans mean unless we have a a clear definition of that it doesn't it's hard to make sense of statements like um trans people are a diverse group um because we don't know what's we don't know what you have we don't know what criteria you have to meet to be in that group so so I struggle with that yeah I suppose that's that's kind of my point is that only connecting theme in trans people is that they've changed their gender so we can't we can't say well you must have done this as well um but but moving on to to some other things I wanted to pick up um Naomi in terms of your comments on children transitioning in the long term effects on on their life of changing gender um do you have any reflections on the long term effects of you know 16 to 18 year olds very often moving on to you know a new life at university or so on um having to start that life living in a gender that is not theirs that the question does rather assume um an answer or a premise that I wouldn't necessarily accept you say think about the effects for a child of having to start a new life at university or away from home um in a gender that is not theirs um but I say think very hard about what you mean by that and whether a 16 or 17 year old um is sufficiently mature and adult um to know if they want to know that they want to and and you say agenda that is not theirs but um they have a body and their body is necessarily either male or female um so we're certainly talking about adopting um a gender expression or a gender identity or something that doesn't conform to their body so they're moving away from if you like the default position and that's what I say is the radical step so I'm strictly speaking we're moving off my legal expertise here anyway so I'm not sure I should go on at length about this but um but the default position is people are the sex they are um and if they want to be legally recognised as a different sex um that is a radical step and that is an even more radical step in the social transition that worries Hilary Cass um as a serious intervention for children and young people can I just clarify there then um trying to pin down what what you've said um do you believe that a 16 year old can be trans I certainly believe that a 16 year old can suffer gender dysphoria and that's clearly the case thank you that's me okay thanks very much um no further questions well thanks thanks very much to all three of you again we've gone a little over the time that I think would would indicate to you but thanks for for giving us your time maybe this would have been one of the sessions that would have been better as a as a round table discussion because I can I get I guess I got the feeling that we're getting into that territory so thanks very much for all your evidence we'll now suspend for about in five minutes thank you okay thanks very much and welcome back to the meeting and I welcome to the meeting David Parker lead clinician at the national gender identity clinic network Scotland can I invite David to make a short opening statement please good morning thank you convener committee for the invitation to come and speak with you today the national gender identity clinical network for scotland endrogens was established in 2014 to support the invitation at a 2012 gender reassignment protocol and aims to improve access to NHS scotland trans healthcare services we're a dynamic group of people representing clinicians people who have lived experience and administrative aspects of trans healthcare in scotland last year we were invited by the chief medical officer to provide expert support to review this protocol and deliver an updated Scottish pathway for trans healthcare based upon a human rights person centered approach and aligning with international standards this work is well underway I would like to speak to the experience of people accessing trans healthcare today in scotland waiting times are considerable with some now four years for an initial appointment evidence due to be published shows that a third of people waiting are already accessing medical interventions including sourcing hormones or surgeries for independent or other providers adverse mental health outcomes are a significant concern and support to those waiting to be seen is crucially important I want to be very clear today our position is that trans and non-binary people are the experts in their own experience we support the uncoupling of medical diagnosis from legal gender recognition we have been grateful for the engagement with Scottish Government representatives in updating and informing us about the proposals for gender recognition and this bill which we see as a legal and administrative process the current process to obtain a GRC is seen by many as a complex system to navigate in order to be properly recognised as their authentic selves we welcome the proposals to make this process more accessible and I cannot overstate the positive impact this will have on the well-being esteem and scientific quality for trans people I'm happy to take questions thank you very much David and again if you start with Maggie Chapman please thanks very much don't excuse me it is still good morning good morning David thank you for joining us this morning I've got a couple of questions firstly around the just can you give us a little bit of a flavour of the kind of support for trans people and others that the clinics provide just so we know what it is you do yes of course so people coming to trans health care services in Scotland are more than likely now to be ready already accessing medical treatment so a lot of that exploration is something that will have been already well under way the services we provide are to offer assessment support to help people understand their experience to give them as much space and time as they need to determine the interventions that may be appropriate for them and to actually then support them when accessing and exploring those interventions so we offer a predominantly very trans health care specific support we're not a mental health service there is of course elements of mental health support throughout the service but predominantly a lot of input that trans people will get will be from mainstream mental health services and third sector organisations which do excellent work thanks very much that's helpful in your opening remarks you mentioned the support for the reclassification the world health organizations reclassification of gender dysphoria could you could you say a little bit more about that and why it is the network has come to the position it has on that absolutely so we were first cited on this several years ago when the scientific process was under way to look at classification agenda and congruence or would there have been transectionism in ICT 10 to what it might become in ICT 11 the scientific papers that were consistently pointing to the direction that this is not a certain mental health condition and arguably isn't a health condition in so far as should actually be something in the ICT at all which is something that's generally defining disease and illness or is it something that should actually come out of the ICT as it came to ICT 11 the reason it's remained is predominantly because it's it's important I think is some healthcare systems that a diagnosis is required to access medical interventions will be essential to help people with gender and congruence so that was the the rationale for keeping it well within the ICT and it moved of course from the mental health chapter into the sexual health chapter as we know and just just following on from that you may not be able to answer this and I accept that but in terms of the trans people that the clinic support how I'm curious around the kind of relationship that the people that you support have with with that process of medicalisation that diagnosis determines what or requires do you do does that come up in the conversations in the support discussions that you have it does and there are there are differences in how people see this I think for a lot of people it's quite an uncomfortable conversation to say that you're going to talk about diagnosis encoding for somebody when it's going to be you're talking very aspiration about things that people are trying to understand and pretty big decisions they're undertaking and this the sense of pathologising this condition for people I think is fundamentally wrong and just reinforces stigma and makes things ever more difficult there are some situations where people actively seek a diagnosis something particularly for example people maybe who are not not born in Scotland who may be looking to change documents elsewhere there are some legal processes which currently require diagnosis and of course the GRC is one of those so it's a conversation that comes up in in different ways and just finding very quickly do you see we've heard in previous sessions that the parallel being drawn around the inclusion of homosexuality in the dsm um with this do you do you agree with with that parallel or is there a comment on that if you don't want to answer that that's also fine because I appreciate it is different I'm happy to answer I wasn't going to bring up because I thought I don't really ever want to link that to as being being linked but actually there's a similarity there of course in that I think I mean homosexuality came out in 1992 it was a very different dsm because evidence suggests that it's not it's not a condition it's not an illness that that should be treated in a medical way so I agree I think has a very very reasonable reasonable comparison thank you and just for the record dsm the diagnostic and statistics manual isn't it yeah thanks okay thanks very much thanks for putting that clarification on the record Maggie too can I go to Fulton MacGregor please? I'm going to be doing a good morning to David thanks for your open statement I've got a couple of questions I was just wondering if you could help us out with I'm just wondering if you can provide any up-to-date information on the current waiting times for initial appointment at Agenda Identity Clinic and how many people are currently waiting for their initial appointment because the waiting times is something that has been raised with us in previous sessions yes thank you thank you very much for the question so I've got figures to the end of the final court in 2021-22 that's the end of march this year we have 4 000 people waiting to be seen for initial appointment in Scotland just over 4 000 people of home 1037 are young people people are waiting different times in different parts of Scotland the most optimistic wait I suppose is currently in NHS Grampian which sits at about 15 to 18 months in the central belt at the moment clinics are somewhere between three to four years waiting time for people as we currently see it with current provision so they're quite significant waiting times as we've heard before what how does that figure of 4 000 compare with previous previous years if you like or maybe not just one year over time though is it is that been a fairly static figure or has it been increased yeah I'm I'm struggling to see the small print on my my shade here I'm thinking that two years ago if I'm reading this correctly it said it looks from the size of the graphic it's about doubled as for the first number of people waiting since the same period two years ago okay thanks to that and then one someone's receiving support from the gender identity identity clinic how long and average does a person tend to receive support from yourselves and I mean I know there's probably varying degrees like it like everything else but is there a sort of averagelyd that you would tend to support somebody for that yes I guess so I guess I mean it was everyone's journey is different and so you you have often quite an active initial phase lots of discussion about what a treatment plan might look like the things that people might want to access sometimes people are ready to move forward on that stage sometimes people move no further forward lots of different hospital outcomes and I I guess if people are starting hormone treatment that's probably about a 12 month period of quite intensive working with somebody sooner maybe three or four times over that next year just to kind of support them that treatment check is meeting their treatment goals that the safety is being well maintained for them and then people might approach other interventions such as maybe surgery in the future they may come to that in a kind of a as they come to that hormone kind of phase they may come back to it many years later so we have a people who are if you like are often actively starting some elements of treatment and they might get to a point where they they continue with the situation where they are they might come back to that in the future so we expect that that there's always like an open door for people we should limit to want to do so in the future that said I mean it's not the case that people have specialist care for lifelong it's not these interventions don't require them thanks very much for that one of the previous answers you talked about the proportion of young people who are seeking appointments and that's quite a high number I wonder if you could expand on that you know what's what numbers we're talking about and if you think and if you've seen an increase in the number of young people seeking appointments there has the increase over the last couple of years has been quite difficult to interpret because the effect of the pandemic which initially certainly greatly reduced numbers being referred to services I suspect worry many services and certainly over the last six months or so I think in all aspects of service including young people service that has increased quite sharply it wasn't increasing that sharply prior to the pandemic so I do wonder whether that might just correct itself um as people who may be now coming forward um that starts the level slightly certainly I think um the data from the good service in London from several years ago suggested that things might be starting to be that if you like the increase it's just starting to tell that to plateau slightly um so so numbers yes are still increasing um and um I think our our planning has been for year on in increases for about 20 in numbers that's been our working position okay um the interim cash review which has been a reference and a number of um the previous panel and and panels um before um has reported an increase in the number of young people seeking appointments agenda identity clinics I accept that's primarily south of the border but are you are you saying that it's possible that that certainly for Scotland anybody that that is is perhaps a outcome of the Covid pandemic then based on your previous answer I think there's been disturbance with the pandemic in the airflow of people being referred and I I do wonder whether the the very sharp increase in the last few months is a kind of was a catching up of maybe people who didn't seek um to get we certainly here in clinical people are still talking about normalting to access their GP being being quite careful about how they are choosing to access healthcare so there may still be I guess another people still coming forward who might otherwise have come forward a little bit sooner okay thank you and go to Pam Gossel please thank you good morning the Royal College of General Practitioners Scotland submitted written evidence whereby they stated that current IT systems do not accommodate for transgender and non-binary patients stating that the trans male cannot be referred for a cervical smear or to a gynaecology clinic if they are recorded as a male in the database despite having female reproductive organs with an anticipated inflation in the number of GRC applications do you have any concerns about decoupling of the legal and medical aspect of the gender reassignment so thank you for the question so I think it's been a case since 2015 that people who are identifying in the the main CHI index which is the community hospital index system which is where most it would be the starting point for most patient records wherever they ultimately end up being kept changes so that has a gender designated which is currently male or female that there's no other option in there at the moment people changing that from 2015 would stay in a system for for cervical smears so people prior to that there may be a work around that needs to happen I'm uncertain about the situation regarding gynaecology and I would be happy to look into that and come back to the to the written answer because I would certainly expect that somebody with male kind number trans men would be eligible to be referred to gynaecology on that David you've said that normal work has to be done do you think it's in line with obviously the bill coming forward now I'm sorry could you could you just basically more work has to be done if it's not been identified with the bill coming forward now obviously I have mentioned that there could be more people coming forward so basically around the readiness of our systems and databases making sure that we are ready so thank you so I think very specifically regarding whether people can be referred into gynaecology I would I think that's a very quick thing for me to check and I would I work in a service where we have a gynaecology aspect I've never it's never been brought to my attention that that's a problem so I would want to just understand a whole bit better because it's not something that's been brought to my attention before regarding the situation regarding chi and other hospital I mean I guess a hospital record is contained often distributed across many different computer systems but that's a big piece of work that will take a long time I think to harmonise and I already it's not dependent upon somebody on a gender recognition certificate so people are really getting to appoint to their transition and they'll make that decision to change their chi number with their general practice at the time that they feel is right I don't think it's going to make a significant difference thank you David I've got a second question that's okay convener the cast review into the gender identity services is on going as you know in England and Wales and it's interim report cited there has not been routine and consistent data collection which means there isn't there is not possible to accurately track the outcomes and pathways that children and young people take through the service given that it's that state of duty to protect given sorry it's the state's duty to protect safeguard children's wellbeing do you think the similar inquiry should be conducted in Scotland followed by more detailed data collection to ensure there are no unintended consequences of the law so I was grateful to be able to see transcripts of some of the earlier evidence sessions to understand some of the comments that we made about data I mean it's a big area and there is certainly data collected in Scotland and I I wouldn't accept the the suggestion that there is there's no data collected in Scotland that there is I think some of the um when it comes to young people numbers in Scotland of young people who move forward to treatment are extremely small and I think this possibly causes a problem sometimes when requests are made for data that the numbers will be such that it's probably impossible to actually give the number because of how small that number would be and to give you an example I think in the average number of young people moving on to puberty blockers in the last certainly seven or eight years has been about seven a year so in some years there will be such a level that none of that data could be reported less alone by a particular uh by by best sex agenda or by health board or or any sort of sort of lower level so I do want to sometimes whether some of the um requests for data have just been frustrated by it is actually quite a limited data set. Do you think that that basically the numbers will increase with the GRC coming in? I I don't I don't see that the GRC is going to make I think the GRC regarding clinical practice it's an interesting so it's a really good question and I think it's it's clearly important if somebody has a GRC that's a substantial act that they've taken and it's relevant to their discussions they will have with their clinicians um in the gender identity clinic however it's one of a a multitude of different uh aspects that we will be looking at and thinking about and I I can't think of a situation and I I've given a lot of thought with where that would even really probably swing something let alone kind of passport something with what I can if I can describe it that way so I yes it's absolutely relevant for that person it will be important for them but I don't think it's going to have a significant it's not going to change the direction that clinical care. Thank you David. Thanks very much and Pam Duncan-Glansia please. Thank you. Thank you convener and good morning or good afternoon almost. David, thank you for for the evidence that you've given us in advance the work that you've done in this area as well and also the questions you've answered this morning. I want to ask a little bit more about the the service and the interaction with the service and the gender recognition certificate just to kind of get under a wee bit. Greater Glasgow and Clyde health board submitted information to the committee and one of the things that they said is that it's important to clarify and highlight the separation between a successful application of a GRC and robust standards of gender identity treatment. Can you set out what you think that separation is for clarity so that we could have it on the record and whether and where they interact and I know that you did touch on that a moment ago in your answer to my colleague Pam Duncan-Glansia, could you also set out where if at all in the gender reassignment protocol a gender recognition certificate comes into play or is relevant? Could you just repeat part of that first question for me please? Is the part about the interaction between the gender recognition certificate and how you phrase the second part please? Sorry I'll try and remind myself and maybe the record will correct me but I think what I asked was about the information we got from Greater Glasgow and Clyde health board saying that it was important to clarify and highlight the separation between a successful application of a GRC and robust standards of gender identity treatment. A lot of evidence that we've had in committee has kind of spoken about both aspects of a trans person's life, so it's just to get your view on the separation of the certificate and the gender identity treatment that goes on in the NHS. It's a very well made point that the robust care that we offer to people as part of their gender identity healthcare is not affected by their decision to apply or having applied and received a gender recognition certificate. It is like anything that people do administratively, it's important, it's a significant factor of their transition that will be relevant to those discussions but for example if we're thinking about criteria for maybe somebody considering hormone treatment all of that discussion is going to be about their needs, their aspirations and their personal goals and thinking about whether technically what is being proposed is feasible for them and whether it's likely to have the outcome they're expecting. So I would see those have been very separated and certainly people will at the moment will will usually not be able to obtain a GRC until that formal diagnosis has happened so we're going to see clearly a shift in that people will probably come to clinic with a GRC. One of the things that I think has always been important is the, I think it was touched on in one of the earlier evidence sessions about section 22 of the Gender Recognition Act and that importance in privacy regarding gender identity and I've always taken a position within network and my colleagues that we treat everybody as they have a GRC because that affords people the right amount of privacy so that for me that means in practice if I'm talking to somebody about writing a letter about them or talking to somebody else about them I'm talking about getting their consent for that so people are fully aware of what's happening and they can be fully participating in those discussions if they wish things to be done in a different way they can say so. So I see them as, there are some intersections certainly but I see them as being very separated and will continue to be. I don't, I may be corrected but I can't recall in the current gender reassignment protocol a specific meaningful discussion about gender recognition certificates and in the current gender reassignment protocol review it has not been a discussion that has been, it's not been a particularly, it will be in touch with one of some of the workings but it's not been a key discussion that we've had. Thank you that's really helpful. I just want to pick up on a point that we've heard in evidence in previous sessions on that. We heard specifically that in Denmark there was a move from self-id to access the gender recognition certificate to self-id for medicalised processes such as gender identity treatment. Is this something that that you could imagine happening here or is this something that's being considered? So the current review there's been a lot of discussions that sort of review is still ongoing but certainly there's been a lot of discussion about what is the access point for treatments within for people seeking trans healthcare and also what is the access point if they're coming back to it rather than at the first stage. So the review is moving forward in principles of realistic medicine so we're thinking about shared collaborative decision making so absolutely people need to be fully informed and able to consent to their treatment but it's a much bigger process than that. It's about working really carefully with the person to help them to access the treatment that's right for them. So I don't see that as something that we're headed towards in Scotland and certainly in the discussions that have included a wide range of stakeholders there's been support for a more accessible way forward but based on realistic medicine principles. Thank you that is also very helpful and then my final question is can you set out, I guess this is probably gone over ground that you already have but just to be absolutely clear, can you set out what impact do you believe that getting a gender recognition certificate would have on a person's ability to receive medical treatment? I can't see it making a significant difference so it's not irrelevant because it's absolutely important part of that person's journey but it's not going to make a significant difference to their ability to receive treatment. I think what it will do particularly where people are so considered in how they approach transition, people will think so carefully about coming out and will often have internally thought about this thing that these things for many years they will tell people slowly and carefully they will decide at what point they're going to change their name, maybe have their pronouns changed at what point they're going to do things formally. Those are not things that people rush into and I think the impact of being able to have that autonomy as to when can I actually make that change at the time that I think is right, I think it's really huge for people and I think it will have a really really good positive impact. Thank you, I have no other questions. Thanks very much and now Emma Roddick, please. Thank you convener and good morning, well afternoon now. How much do you think a lack of awareness of the different experiences of trans people going to gender identity clinics and the different choices that they can legitimately make about what their journey looks like impacts on public views on what the process for a GRC should be? Gosh, I don't know, I don't know, I really have enough awareness of the public's understanding to answer that but I suppose I can say no, certainly even within health there is often not a great understanding of actually what's happening and certainly if we think about some of the questions that were asked and people just maybe just general questions or information, yes there is a misunderstanding that I think there is a there is not always an understanding this is a very it's a very deliberative considered process. So this isn't something that people are rushing into and whilst I think it's important to say sometimes I think people are saying I'm really frustrated with the amount of time I've had to wait, I just want to get things moving along but actually when they arrive that stops and people are wanting to be really careful about what does this mean for me, what do I want to do and I think yes I think sometimes it would be nice if it would actually be more open about actually what happens here. This is about a really is a very it's a mix of lots of different times of things that go on but they are very person-centred, they are very need-led and there's certainly no prescriptive process throughout. Is this interesting news, the word prescriptive, because I think in the previous session we were talking about is there a standard of proof which you know gender dysphoria or something in its place that all trans people could meet to prove that they are trans before getting a GRC? In your view is there anything that could fit that that could apply to everyone who is trans in order for them to get a GRC? I've never been able to think of a really common analogous situation to experience a gender and congruence that people experience. Very rarely people have quite significant other comorbidities which interfere with their sense of or something might be quite uncertain so people might be uncertain and that's certainly not uncommon and therefore thinking about how do I get to understand this better, how I get a better understanding of my experience and there are other people who have gone past that point and actually their sense of that that they're assigned sex at birth and experienced gender is clearly mismatched. I can't think, certainly can't think really of an analogous situation that people would really mistake for that and certainly whilst people do talk about that process of how do I get to where I am you know I realised something wasn't maybe quite right or something was different and people would talk very eloquently as to how they have tried to maybe test different things so maybe the first thing I noticed is that I've got some particular feelings about this part of my body or something that's psychologically is happening for me but actually they work these things through to a point when I say I'm certain this is what it is. It's a very it's a very consider thing. Okay thank you for that. Moving on specifically to services I'm very aware as a Highlands and Islands representative that currently all the clinics are based in cities and do you deal with many people who are located in rural and island locations and are there barriers whether you know real or perceived that people are coming up against when accessing your services? I think one of the key changes since the start of the pandemic was this very quick move where it hadn't happened already and I think in Highlands and Islands they were probably ahead of the game actually of thinking about how virtual healthcare to any health is actually delivered and how it's delivered well and certainly that is now common in gender identity clinics. We are doing a lot of video working a lot of thinking about actually what are other ways of doing this and just thinking beyond that kind of structure sense of where you have an appointment for this that or something else there's other ways to kind of get information or to kind of keep in contact with somebody throughout their healthcare. So certainly yes it's definitely changing and I think that's a huge benefit for people certainly more rural areas but actually also people who are just busy and it's that interruption to their day and it kind of normalises things a little bit better for them. Absolutely thank you and that's all my questions. Thanks very much and Rachel Hamilton please. I've got a succession of quick fire questions if I may. How many people using your services seek to obtain a GRC currently? Do you keep that data? I don't have that data to hand and I don't know that we keep it. So if somebody came to seek medical treatment to obtain a GRC you keep that data do you but if they seek medical treatment but don't obtain a GRC you don't or neither? So I think to get a GRC at the moment he requires two reports one will come from your GP and the other will come usually from a gender specialist which is the psychiatrist report that we're talking about so there's two medical reports required. The GP one is usually straightforward although there may be a cost charged by some practices to obtain it. The psychiatrist one is often going to be for those people who've had surgery or have had a psychiatry appointment during their their episode of care and they will use the letter from that appointment as part of their GRC application so for that reason I may not know that somebody has applied for a GRC they will have evidence they could use but whether they they wouldn't have necessary approaches for that purpose so people could could make a GRC application and already have that evidence so we wouldn't be able to record it if that makes sense. Okay so if a fewer trans people seek medical treatment to obtain a GRC by self-decoration how do you know for the future what your service provision should be? Very few people are, I'm sorry if I've misunderstood your first question, very few people are accessing a gender identity clinic solely for the purpose of getting a gender recognition certificate, sorry if I've misunderstood you. It's very rare, I can only think of a hand for the occasions. That's helpful. Do you have a minimum age for service provision within your clinics? The clinics do, so the adult clinics are 17 or 18 depending on which clinic and young people service. I don't know that there is a formal minimum age at the young people service. Has there been any analysis of the service provision need bearing in mind that there is a long waiting list if for example 16 year olds required that your services, how do you know what the future holds for waiting lists because the whole objective of reform is to ensure that trans people are able to access services or get a more dignified experience? Absolutely, so I think the reason why we got to where we are is a combination of services not always having the most secure funding and also a considerable increase in demand for them. I think that both of those are factors in how we've arrived at the situation where we are today. The Scottish Government strategic action framework and funding that was announced last year, there are plans, mind telling is all of the things now, well in the process of putting together cases that will be applications for funding for this year and then thinking about what needs might be for future years. There was also an interest in thinking about whether there might be new services that might be possible in Scotland, whether that's from a health board that currently doesn't have a gender identity clinic, whether there might be, for example, a primary care based service that might want to apply and to be developed and funded, certainly similar to some of the plans that are now happening very successfully down in England. So I think that there is now work underway and certainly as part of that has been all of the services that we're done modelling understanding there, the resources required obviously and the extent of their waiting times. You don't need to answer this question, but do you believe that the service provision should have been put in place before the reform? I'm not sure that I quite know how to answer that question. I know it's slightly unfair because obviously it's a very wide question and quite subjective. However, another tricky and challenging area is that some witnesses who are opposed to this bill have raised concerns that there could be medical oversight in the GRC process itself and that a chance that other issues could be overlooked such as mental health. We had a submission here from the RCGP who talked about the vulnerabilities of young people, heightened risk of self-harm and suicide. Do you have any concerns about those particular challenges? Absolutely, I have concerns about those things. As part of the proposals to reform services, it's not simply to put, to make more clinic appointments and to enable a pathway forward for people on the waiting list. It's for people who will never join the waiting list, so community support for people who may be looking for all kinds of intervention that's available to them, because you're absolutely right. If numbers of people on the waiting list are increasing or referrals are increasing, that need is increasing too. Lastly, do you think that fewer trans people—this is based as a follow-up to that question—might seek medical treatment if they're able to obtain a GRC by self-declaration? Could that have unintended consequences, referencing the last question that we just talked about? I think that, really based on the very few numbers that currently seek GIC referral just for the purpose of getting gender recognition, it's undoubtedly true, but I think that the numbers will be very small. How would one go about getting a GRC and getting the paperwork without seeking the services of the GIC? What are the normal routes to that? It's the only way currently that you would be able to achieve that is by commissioning an independent report, so you would effectively go to a private provider who would be able to give you a report that would be suitable for the gender recognition panel. The national health service in Scotland is not the real route to getting that certification, then? It absolutely is a route for people if they wish to follow it. I suppose that my belief, and based on some examples that I know of, is that I know that that's what people have done. So they have seen it as an easier option if they've been able to do that. That's the way I can get those figures if data isn't collected. If I understand you correctly, that would be the number of people getting GRCs through private providers. It's possible that the gender recognition panel might have data on who's providing the reports. That might be one way to do so, but as the NHS, we wouldn't have known about that, so we wouldn't have that data. Thank you. Thank you. I don't think that we've got any more questions. Thank you very much, David. That's been really helpful. That concludes the public part of our meeting, so we'll now move into private for the final items on our agenda. Thank you all very much.