Seòmar agus comataidhean

We talk about the use of vapes in smoking cessation, but, ultimately, they represent a very small proportion of those that are used. When I walk into my local Asda or other shops, I see vapes being sold in prominent places. Some have lights on the sides and they have very bright colours. It is literally the opposite of what we have done with cigarettes. Is it fair to say that the industry is targeting children with the way that vapes look?

Although I support the motions that are before us, as I said in my questions, it is important that we understand that, because some people who carry out procedures are not in one of the groups that are being regulated, we have almost a cowboy market, where anyone can do whatever they want with no checks or balances. Patients can suffer significant side effects and significant costs are incurred by the NHS. Therefore, although I am happy that we are seeing some movement from the cabinet secretary, I feel that it is a shame that nothing has been put in place since the 2020 consultation to protect citizens who are looking to get things such as fillers done.

I have a final question, Dr Cass, if I may. An important area is regret and detransitioning. What does your research show about the number of children who experience regret? Indeed, has it been able to show that? You have said that puberty blockers are irreversible, so what do we then do with children who face that issue?

Dr Cass, I know that adult services were outside the scope of your review, but you mentioned them in your report. At paragraph 19.31, you stated:

“There was an expectation that patients would be started on masculinising/feminising hormones by their second appointment, which was a cause of concern given the complexity of presentations.”

Did your research show anything similar for children’s services?

I declare an interest, in that I am a practising NHS GP. I am a bit disappointed to hear that the issue of a reduction in red meat is due to the climate report, not simply to a discussion about healthy eating. I was glad that Dr Purdon eventually spoke about the risk of colorectal cancer. Ultimately, we need to eat a wide and varied diet, with a rainbow plate; one portion of red meat a week; far more fish; and far more vegetables.

I am also glad that Dr Purdon mentioned the food environment, because that is what I want to speak about. I have heard that all branches of Greggs are approximately 200m from a school. Is that accurate?

I believe that meal replacement shakes are part of a diet culture. A huge proportion of people—I suspect, most people—have been on diets, on and off, for their whole lives. Do consumers feel that things such as meal replacement shakes are healthy alternatives to eating well? If you do think that, what have you done about it?

On the perception of healthy foods versus what is actually healthy, a lot of people think that cereal bars are a very healthy alternative to having breakfast, whereas they are in fact full of sugar, salt and other things. A lot of foods are perceived to be healthy but are patently not. What research have you done on that and on the public’s perception of what is healthy?

I declare an interest as a practising NHS general practitioner.

Thank you for joining us, Dr Cass. I have grave concerns about the use of puberty blockers for children, given the paucity of evidence and given that the early intervention study did not demonstrate benefit. I feel that ideology and dogma have no place in medical treatment. Given that you have stated that young people’s gender identity is “fluid” and that there is “no hierarchy”, do you feel that there is an age where it becomes more fixed?

Certainly, the things that I believed when I was a child are very different from the things that I believe now, as are the things that I feel are or are not important.

In your report, recommendation 8 states that we should be looking to prescribe medication at 18, and recommendation 6 states that we need a trial. If medication were to be given below the age of 18, would it be appropriate for that to happen without parents’ knowledge, or do you feel that 18 is the right point? Also, given your previous statement, why did recommendation 8 state 18 as the age?

I have major concerns about private treatment. Throughout your report, you talk about a multidisciplinary team approach; it is, in fact, mentioned in recommendation 9. In that case, should a single private practitioner be prescribing medication? Is it appropriate for that to occur?