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Lord Tebbit: My Lords, I am, of course, disappointed but not unduly surprised by what the Minister said. He tempts me to enter into a Second Reading debate. It is a temptation that I shall resist manfully. As we proceed through some of the other amendments, he may see more clearly my objection to the Bill—not least the objection that it would require officials to certify something which was simply not true.

On the subject of the way in which the business is managed, which has received some criticism today, I should say that I am extremely grateful to the Government Whips' Office for moving out of this group Amendment No. 86, which I did not believe belonged there. We can deal with it later. Therefore, I am grateful for that.

I understand the dilemma facing the noble Lord, Lord Filkin, who is expected to be in two places at once. It is a very difficult situation. I can only offer him

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the possibility of the judgment of Solomon as one way out, although I do not think that he will be particularly keen to take it.

The Minister seemed to introduce a new concept, which I believe we might call "linguistic relativism". It seems to have led him to the conclusion that we should legislate using words whose meanings we do not understand and which mean different things to different people. I do not believe that that is a good way in which to legislate. If we use a word in legislation, we should be prepared to state its meaning clearly and unequivocally and say how it differs from the meaning of other similar words which might be used as a substitute for it in legislation.

The noble Lord, Lord Turnberg, suggested that I might not understand the relationship between the words "sex" and "gender". However, sadly, when it came to the point, he could not define either of those words, which he used quite freely, nor say what he meant by them. Again, if I may say so, it seems to me that that is a lacuna in his argument.

I was brought up in a profession which, like that of the noble Lord, places human life in the hands of its practitioners. However, it was one in which we were expected to know precisely and absolutely the meaning of the words that we were using because, if we did not, it would prejudice life. Recently we have seen in the medical profession one or two spectacular cases where doctors did not understand the meaning of the words "left" and "right", let alone anything else, and thereby prejudiced life.

The noble Lord, Lord Carlile, says that to substitute the word "sex" for "gender" would wreck the Bill. It must be a very delicate Bill if it would be wrecked by substituting a word that we can not define with another word that we can not define—but which says pretty much the same thing anyway. That does not seem to have the savour of a wrecking amendment. I find the matter profoundly unsatisfactory. Of course, I am a realist and we need to move on with the debate on other amendments. I do not propose to divide the House on this amendment, and I beg leave to withdraw it.

Amendment, by leave, withdrawn.

[Amendments Nos. 2 to 11 not moved.]

2.30 p.m.

Schedule 1 [Gender Recognition Panels]:

Lord Chan moved Amendment No. 12:

Page 13, line 11, leave out "or chartered psychologists" and insert "recognised as currently practising in the field of gender dysphoria in the United Kingdom, or who have an entry in the specialist register held by the General Medical Council which confers their eligibility to practise as a consultant psychiatrist within the National Health Service"

The noble Lord said: My Lords, I rise to speak to Amendment No. 12 and all of the other amendments in my name—Amendments Nos. 13, 15, 16, 20, 22 and 23. In Grand Committee I did not speak on the composition of the gender recognition panels, because

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I was researching the requisite qualifications of the medical members proposed in Schedule 1. Therefore I shall dwell first on Amendment No. 12.

Clearly, the role of medical members of the panel is to determine the validity of applications, in particular the clinical diagnosis of the applicant. Gender dysphoria, as the Minister said, is accepted as a medical condition by the Chief Medical Officer of England and patients are entitled to treatment on the National Health Service.

In clinical practice consultant psychiatrists validate the diagnosis of gender dysphoria. As it is a specialised area of medical expertise only a limited number of consultant psychiatrists are recognised as specialists in gender dysphoria. I have taken the liberty of excluding chartered psychologists, because in current practice they do not diagnose independently people with gender dysphoria. Clinical psychologists are technically members of the medical profession. Diagnoses of that medical condition are made by consultant psychiatrists, who may use the services of a chartered psychologist to determine the psychological profile of the patient.

When considering something as important and, literally, life changing as an application for gender reassignment and for a gender recognition certificate that overrides and cancels a person's birth certificate, I am convinced, as I hope other noble Lords are, that the expertise of the gender recognition panel must be of the highest professional proficiency. Therefore, Amendment No. 12 is designed to identify registered medical practitioners who are currently practising in the field of gender dysphoria in the United Kingdom, or consultant psychiatrists in the National Health Service who are registered with the General Medical Council.

In Amendment No. 13 I ask for two medical members to be appointed to all gender recognition panels. My reason was influenced by the current re-examination called for by the Attorney-General of all criminal cases involving more than one sudden infant death in a family, where a medical expert has been used by the prosecution. A similar situation has arisen in the past week in the case of the United Kingdom's best known expert on trans-sexualism, who is a consultant psychiatrist at Charing Cross Hospital, and is being investigated by the GMC after claims by a dozen patients that he put their health at risk—according to an article in the Guardian on 20 January. I quote:

"Consultant psychiatrist Russell Reid, a specialist in gender identity disorders, allegedly breached standards of care by prescribing patients with sex changing hormones and referring them for genital surgery without adequately assessing them".

The standards by which Dr Reid should have conducted his practice have been recognised by other consultant psychiatrists in the field, who say that the guidelines they use are set by the Harry Benjamin Gender Dysphoria Association, based in Minneapolis. The guidance states, the article continues,

"that patients should have been living in their desired gender role for at least three months before prescribed hormones, or had at least three months of psychotherapy. Patients should also undergo

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a minimum of 12 months' hormone therapy and live in the desired gender for the same period before referral for gender change surgery".

Therefore, as other noble Lords and the Minister have mentioned, it is a long process and a decision that the person wanting to change his or her gender has to consider very carefully. Regarding that problem of medical experts, we see that the recommendation in Schedule 1 states that there should be just one medical practitioner as a member of a panel. That position is no longer tenable because of the difficulties that arise from expert witnesses with a medical background. In view of such allegations it would be best practice to have two medical members on a gender recognition panel.

Amendment No. 15 arises from the need to be sure that applicants for gender recognition certificates have been convinced that their condition is permanent. The period of two years in which the applicant has lived in his or her acquired gender needs to be verified to avoid complaints such as those levelled against Dr Reid. The GMC is investigating allegations that the patients did not have enough time to change their minds about their preferred gender. Although all transsexuals consult their GPs, who refer them to consultant psychiatrists, the nature of their condition may lead some to change their minds about gender reassignment. I hope that all transsexuals have the support of their families and partners when they apply for a gender recognition certificate. To establish that support, the transsexual person should obtain confirmation from two qualified witnesses—naturally one would think of doctors, but they could also include close family members and partners—to verify that the person has indeed been living in the chosen gender for two years.

That leads me on to Amendment No. 20 which deals with evidence: evidence which makes it clear that any applicant for a gender recognition certificate should have been under the care of a registered medical practitioner practising in the field of gender dysphoria or a consultant psychiatrist specialising in gender dysphoria.

I have not come across the names of non-medical practitioners who currently practise in the area of gender dysphoria. It is therefore appropriate that the Bill specifies the qualifications of medical practitioners who are recognised and whose reports are the evidence needed by the gender recognition panel. After all, we have identified that gender dysphoria is a medical condition recognised by the Chief Medical Officer, so it is only appropriate that medical evidence is produced from reports by medical practitioners.

I tabled Amendment No. 16 because it is true that the majority of applicants have undergone sex reassignment surgery because of the two years which has been given for them to be convinced that they would live in the gender of their choice. Sex reassignment surgery is a sign that the applicant is convinced that it will be a permanent change. From experience of transsexuals in Australia, New Zealand

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and parts of the United States, there should be no doubt that such an individual should be given a gender recognition certificate.

Of course there will be some transsexuals who on medical grounds of serious life-threatening diseases are unable to undergo sex reassignment surgery. Those cases can be judged on individual merit by the gender recognition panel.

Another reason in favour of the amendment that requires applicants to have undergone sex reassignment surgery has been the regular reports of the rape and murder of transsexuals that I have read. They have taken place in Australia and in this country. The view I have gained is that most such tragedies affect transsexuals who have not undergone sex-change surgery. When an individual has undergone sex-change surgery, there is no reason to deny her or him a gender recognition certificate.

Finally, I tabled Amendments Nos. 22 and 23 so that objective evidence is obtained of the applicant's determination to live in the preferred gender. These amendments should also help to exclude applicants who are not qualified to obtain a gender recognition certificate. I beg to move.

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