Nesbitt decision to halt puberty blockers trial is 'disgraceful' - O'Neill

First Minister Michelle O'Neill has described as "disgraceful" a decision by Stormont's health minister to suspend Northern Ireland's participation in a clinical trial to assess the risks and benefits of puberty-blocking drugs in children who question their gender.

Participation in the trial was reported last week in a review of Northern Ireland's gender identity services carried out by Dr Hilary Cass.

However, Mike Nesbitt has now suspended Northern Ireland's participation in the trial.

On Monday, Nesbitt defended his decision saying he acted in light of ongoing legal action.

The minister said he had also reached his decision as he sensed "we were on the cusp of an issue developing into another executive row".

Puberty blockers, also known as puberty suppressing hormones (PSH), are drugs used to delay or prevent puberty happening.

Earlier on Monday, O'Neill said the minister should have brought the issue to the executive first before making the decision.

"It's unfortunate the route Mike has taken, you only have to look at the UUP's social media to know this is more about inter-unionist rivalry - that's disgraceful, to turn their head against the trans community."

The first minister said she felt the decision should have been handled "in a much more sensitive way", and that she distanced herself from it.

Appearing before assembly members on Monday afternoon to answer questions about how the decision was reached, Nesbitt explained the reasoning behind his decision.

"Gender identity is too sensitive and important an issue to see those young people, their parents and many others seeing this issue dragged through the courts or subject to the lowest form of the debate," he added.

"I think it is prudent to pause and wait on the results of the judicial review."

The minister added that in the event that legal action finds the clinical trial can go ahead, he will take the views of executive colleagues before lifting the suspension.

DUP MLA Diane Dodds, whose party tabled the urgent question on Monday, asked why it had taken the minister so long to reach his decision and suggested he had only done so following pressure from her party.

"If it was unwise on Friday, why was it acceptable when your party defended it on Thursday?"

Nesbitt said he had come on a "journey" in reaching his stance and said the issue was "incredibly complex and emotive".

In a statement later Dodds said "the only thing which changed between Thursday and Friday was the formal intervention of the Education Minister making clear that any such clinical trial would require Executive support and that no such support had ever been granted."

However the UUP said the DUP was "typically engaging in further diversionary revisionism on this matter" and the decision to suspend Northern Ireland's participation was not in response to Paul Givan's letter.

An Alliance spokesperson accused the health minister of "buckling under political press from the DUP".

"Just over 24 hours before, Mike Nesbitt was still advocating for Northern Ireland's inclusion. Healthcare decisions should always be based on expert advice, not internal party dynamics or short-term political expediency," the spokesperson said.

Earlier on Monday, UUP leader Jon Burrows told BBC Radio Ulster's Good Morning Ulster programme the health minister - who is also in the UUP - made the decision to pause the trial "independently", adding: "That's absolutely proper."

In a statement to The News Letter, Nesbitt said that if the trial was "given the green light to proceed, I shall take the views of executive colleagues before any potential lifting of the pause."

In September, the health minister appointed Baroness Cass to review Northern Ireland's gender services.

Baroness Cass is a consultant in paediatric disability and a former president of the Royal College of Paediatrics and Child Health.

She previously carried out a review of gender services for young people for NHS England.

It found that children had been let down by a lack of research and that there was not "good evidence" that puberty blockers, which pause the physical changes of puberty, were safe or effective.

Researchers from King's College London are carrying out a clinical trial involving about 220 children under the age of 16 who are going through puberty.

The trial will examine the impact of the drugs on their physical, social and emotional well-being.

Some campaigners have said it is unethical and could harm children.

The Rainbow Project said it "unequivocally condemns" the move.

"The Executive claimed that its ban on puberty blockers was based on evidence: this decision is very clearly based on politics," said Alexa Moore.

"This clinical trial was held up by Executive parties across the board as a means by which to gather the evidence for the use of blockers, assess their safety and efficacy, and make a decision on their use on that basis."

Baroness Cass was asked to examine whether planned changes to services for young people in Northern Ireland complied with the recommendations from her review in England.

Her review included meetings with staff and users of gender identity services in Northern Ireland.

Baroness Cass' review called for better research into the characteristics of children seeking treatment and to look at outcomes for every young person.

She said that gender identity services for young people in Northern Ireland were helped by referrals coming from Child and Adolescent Mental Health Services (CAMHS), which ensured early mental health treatment when needed.

However, some CAMHS staff expressed frustration "that there are children and young people on their caseload who are awaiting the KOI service but cannot access it".

The Knowing Our Identity service provides help to children, young people and their families in relation to gender related problems.

The review contained a number of recommendations but said that clinical practice in Northern Ireland should be aligned with that in England.

Baroness Cass said, though, that the Lifespan model should enable "a much smoother 17-25 year transitional care pathway" from children's to adult services.

In a statement last week, Nesbitt thanked Baroness Cass and her team "for taking the time to conduct this assessment during their visit to Northern Ireland in November".

"I hope this report gives assurances that the new Lifespan Gender Service is compliant with Dr Cass' 2024 review, and that the decision to invest in new and additional psychological and psychiatric support is the right approach," he said.

In July, he had faced criticism from some unionist politicians after more than £800,000 was allocated to gender identity provision in Northern Ireland.