Bridget Phillipson's assurance that 'refusing to accept a child's identity' will not be prosecutable under conversion practices legislation is contradicted by the bill itself, which says that 'psychological or emotional pressure' with the intention of changing 'transgender identity' could qualify as a criminal offence. How can Phillipson know how a court will interpret 'refusing to accept a child's identity' given the vague and open-ended definitions in the bill? An op-ed by a politician will be scant consolation when a parent is facing a criminal claim or a protection order that will destroy their relationship with their child. And the question remains: what 'abuse' is the bill designed to tackle that is not already an offence in law? archive.ph/BDRJN

Safe and effective care for gender-distressed children and young people will only be achieved when clinicians, policymakers and researchers are prepared to acknowledge and address the serious shortcomings in the diagnostic frameworks. Following its recent consultation, the National Institute for Health and Care Excellence (NICE) admits that stakeholder feedback highlighted extensive limitations with the diagnoses of gender dysphoria and gender incongruence (DSM-V and ICD-11). Sadly, that feedback is ignored in NICE's recommendations, where diagnostic limitations do not even warrant a mention. Instead, NICE continues to use these flawed diagnostic labels as the basis for recommending risky medical pathways. NICE recommends: "long-standing gender incongruence should be an essential pre-requisite for medical treatment", albeit with the concession that this should be "only one aspect of deciding whether a medical pathway is the right option for an individual". What NICE fail to ask is whether a diagnosis of gender incongruence offers any value at all in making such a decision. This is especially puzzling since the Cass Review emphasised that "Although a diagnosis of gender dysphoria has been seen as necessary for initiating medical treatment, it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them." The lack of predictive power for gender dysphoria applies equally (arguably even more so) for a diagnosis of gender incongruence. NICE offers no explanation as to why a diagnosis of gender incongruence is deemed necessary (albeit not sufficient) before embarking on puberty blockers or hormones. No information at all is provided about the additional "aspects" that supposedly enable a decision that "a medical pathway is the right option". The basis for decision-making is thus a flawed diagnosis plus unspecified other factors. Indeed, this is exactly the model being followed by KCL PATHWAYS in the puberty blocker trial.