The BBC Health Hub and sex and gender

Our submission to the Thematic Review

Please bear in mind that this submission, as with other submissions, was made before the Supreme Court ruling on biological sex. However nothing has changed since then: except that the BBC has even more reason to adjust its approach.

Our concern is with impartiality across the BBC’s journalism on sex and gender. We take a clear view, that impartiality is

• Establishing the facts

• Publishing the facts

• Curating and publishing a range of views around the facts

The basic facts on sex and gender are that being male and female is an unchangeable reality, based on reproductive role. Facts should not be presented as opinion: and around these facts, views should not be excluded from ‘either side’.

This means we may have a different perspective to campaign groups who feel their communities and their voices are badly represented by the BBC, or not represented at all. We cannot speak for these communities and we hope the Review team is able to find stakeholders who can.

• scientists and biologists can provide research that can help with facts and data

• women’s groups can offer a perspective on how women are affected generally

• fraction-goups within that can offer perspectives on how families are affected by transition

• lesbian and gay campaigners

• trans rights groups who will also be approaching you internally and externally

We do not represent any of these groups. What we hope for is that impartiality is restored and sustained going forward.

Colleagues within the BBC

We hope very much that the team understands that many journalists within the BBC who hold ‘sex realist’ views may be reluctant to come forward for fear of repercussions.

Staff networks

If you are consulting staff networks, it’s important to note that the staff network ‘Women at the BBC’ is an ‘inclusive’ group which accepts and supports belief in gender identity. This can be confirmed with them. It cannot therefore speak to a ‘non gender identity’ framing. There is no Sex Equity staff network at the BBC.

Sex and Gender Health Reporting by the BBC

Seen in Journalism submission

We will limit our examples and analysis to a manageable level.

We see the main difficulties here a very short time after the period under consideration - April 10 2024 - with the publication of Cass Review. As it is just outside the parameters, and as the Cass Review was of such significance, we hope you will allow us to critique BBC coverage.

Why is it so important? It demonstrates something of a decline in the quality and impartiality of coverage since the departure of Hannah Barnes, a trend which we hope will shift as a result of the Review.

There are two main issues with regard to sex, gender and health:

• medical transition

• single-sex spaces

and two kinds of bias:

• bias by omission

• langage and framing

The story falls into several camps: Health, Politics, Women and LGBT (there is no Women’s Correspondent). Within this set-up, the LGBT team acted as a type of gatekeeper due to the reluctance of other teams to take it on.

The major issue is the failure of the Health team. The BBC was fortunate in having Hannah Barnes of Newsnight still in its employ for half the year under consideration. She left in October 2023, but until then continued the ground-breaking work she began with Deborah Cohen, on child medical transition and the Tavistock. Barnes was meticulously impartial.

Children on puberty blockers saw mental health change

Consequently during her tenure, much of the BBC’s work on medical transition between April 2023 to March 2024 was fair. Fault then lay in giving it to the LGBT team, rather than the Health team: thus imbuing it with a ‘trans rights’ framing rather than a health framing.

The story was rapidly turning into one of the gravest medical scandals of the decade, but was given to the LGBT Producer, even as the final Cass Review was in preparation. An example:

NHS England to stop prescribing puberty blockers March 12 2024 by Josh Parry

Here we see the problems caused by that framing, and they are typical of BBC coverage. If you need more links, we can supply. As you will know, the convention for journalists is to have the most important information in the first four paragraphs. Here we have this at the top:

‘Puberty blockers, which pause the physical changes of puberty’

Despite the wealth of evidence in the public domain about puberty blockers and their risks, including the fact that they are powerful cancer drugs and are prescribed off-label for gender dysphoria, nothing more is offered. This sentence was probably based on this 2021 factcheck:

Keira Bell case: What are puberty blockers?

which has yet to be updated and which remains the only fact check published by the BBC on this subject. It is the top response on a BBC search for ‘what are puberty blockers?’, a search which it is reasonable to assume an inquiring parent or child might make, expecting the BBC to supply a comprehensive response.

Framing puberty blockers primarily as a ‘delay’, as in most BBC pieces and the fact check, is an activist position. It plays down the central issue (and the reason for any controversy at all) - the health impacts of puberty blockers on children.

To demonstrate that this ‘playing down’ is still the BBC’s main framing, we include these:

Puberty blocker ban extended to Northern Ireland

‘Puberty blockers work by suppressing the release of hormones and can be prescribed to children questioning their gender’

BMA calls for ban on puberty blockers to be lifted

‘These drugs suppress the natural production of hormones and delay the onset of puberty’.

The last is from as recently as last month. Note that they still don't include any information about puberty blockers other than that they constitute a ‘delay’ or ‘suppression’. We want to show that this problem has not gone away.

Consequently we make three recommendations:

• an updated fact check on puberty blockers and cross-sex hormones is published with full reference to all the possible impacts. This should be separate from the upsum of the Cass Review and include the fact that almost all children who are prescribed them go on to take cross-sex hormones, usually resulting in sterility.

Crucially, there are also fears that they may ‘lock in’ gender dysphoria. It should also include the fact that neither puberty blockers nor cross-sex hormones will change a person’s sex. It sounds obvious but it should be spelt out. Facts should be at its heart.

• Such a comprehensive fact check on medical transition could then be linked to by every piece of journalism the BBC produces on the subject, and would be a useful internal reference guide for presenters and producers.

• We would also recommend the BBC produces a body of journalism including ‘personal journeys’ of medically transitioned people - those who detransition and those who do not - to talk about the reality of this life-changing treatment. For example there are older adults who transitioned when young and do not regret it, but who believe young people need a much fuller knowledge of what it entails before embarking on that path. This has been one of the greatest omissions of BBC coverage.

BBC coverage of the Cass report - 10 April 2024

By the time the Cass Review was published, the level of impartiality on medical transition at the BBC had sunk further. The Review’s final report was front page news across UK media and in many global outlets.

The BBC covered it with a trans-centric approach rather than focusing on the child patient group or the serious health impacts. Here we outline the main issues.

1. Missing the story and misleading with key points

The BBC’s main headlines were focussed on waiting lists and the toxicity of the debate. It strongly implied that waiting lists were Cass’s primary concern, and that the changes in protocol which she recommended were to manage the ‘waiting list’ problem.

This was highly misleading. Cass makes clear that waiting lists are merely a symptom of much wider and more serious failures. Waiting lists were barely mentioned in other outlets’ coverage, because they were a side issue compared to how children had been failed by being given experimental, unevidenced treatment with serious consequences.

Toxicity of debate was headlined every hour, and included in most introductions and voice pieces, TV packages, online write up and every interview. Despite giving it this primacy, the BBC never subsequently explained that Cass’s fear was that ‘toxicity’ prevented healthcare professionals handling their patients appropriately. Her concern was about excessive affirmation and prescription, but the BBC failed to explore that the ‘toxicity’ consisted largely of a fear by HCPs of being accused of transphobia if they failed to affirm a child for treatment.

These two issues - waiting lists and toxicity - were minor compared with Cass’s main findings and recommendations about the harm to children from unnecessary medical intervention. But they were the issues which most successfully minimised the more serious findings, including the possibility that gender activism may have led to policy errors.

2. Failure to explain the report

This was a complex 400 page report. There was no breakdown, no Q and A, no accessible analysis, as most other outlets prepared. The BBC had time to offer more than a solid block of sludgy prose but chose not to.

Links were chosen, from the start, largely for their affirmation of the waiting list line, or in one case to a piece that voiced gender activist concerns from within GIDs. They included this activist glossary, and this article implicitly blaming waiting lists for deaths of trans people.

Internally, the producer briefings and backgrounder were so poor that at one point, a presenter compared puberty suppression to getting a tattoo and asked ‘are we infantilising people’ by restricting the use of GNrH analogues.

Even now, there is no ‘Cass Review’ page, while there is an Infected Blood page, and even Transphobia, Drag Queen,and Pride pages.

3. Centring adult males with trans identities

The BBC’s approach to balance was to have trans-identifying males question the integrity and motivation of the Cass Review without evidence.

Planning across Radio 4 and Five programming, and live and continuous TV news, focused on the voices of trans-identifying males who are content with their medical transition. The contributions of these male trans people were also clipped up and deployed across news summaries and bulletins, expanding their reach even further.

To understand how activist this framing was: an analogy would be the infected blood story, and the BBC choosing to carry every hour an interview with people who received blood transfusions and were not infected and didn’t understand why there is a problem. Or, in a story about a maternity unit deaths, carrying an interview every hour with a different mother who hadn’t had any problems at all at the hospital.

Finding a satisfied patient is not a responsible or relevant counter to the output of experts.

There were more trans-identifying males than any other collective group of contributors. This was a story about healthcare, children and medical malpractice. There was no journalistic need to centre adult males with no clinical knowledge, to give them time to evangelise about their own medical transition.

The transitioned men were also given longer than other contributors: as an example, on Radio 4 PM, the respected psychiatrist and Tavistock whistleblower Dr David Bell was given 5’15” while trans journalist Amelia Hansford was given 7’30”. On Newsnight, the voice of a clinician was ‘balanced’ by that of a trans-identifying male who was satisfied with the treatment received at GIDS. They were used to balance factual contributors, although their own contributions were anecdotal and activist.

Since a primary concern in Cass was that young females are now over-represented in the patient population, and that medical transition might in some cases not be in the children’s best interests, the perspective of these males was of no relevance, but was not interrogated at all. There was also an absence of contributors who were detransitioners, young patients who had suffered and still suffer because of medicalisation - the most relevant group to which a voice should have been given.

The framing is clear: for the BBC, this was not a medical health scandal, this was a pro vs anti ‘transgender rights’ issue. We hope the Review will understand that this framing is problematic. The scandal of climate change would not be framed as a pro vs anti debate on the rights of climate deniers. The BBC needs to detach itself from this perspective.

4. Missing the relevant voices

It’s possible that clinicians were reluctant to comment: repercussions are still real. However other relevant voices were omitted:

• Transgender Trend, the campaign group which has reported on this since 2015, and was the first to publish data from the GIDS puberty blockers trial

• Parents’ groups such as Our Duty and Bayswater Group

• Trans-identifying females (highlighted by Cass report, unlike trans-identifying males);

• Detransitioners. Only archive footage of Keira Bell was used

• Health experts to explain the impact of puberty blockers and cross-sex hormones;

• A post-operative person to explain the reality of living without functioning gonads, sterility and the health implications

• A psychiatrist to explain brain maturation and how it is affected by puberty suppression

Single sex spaces

This is hard to critique as there was so little BBC coverage of this across the relevant period, despite multiple stories across other outlets. The BBC ignored for example the story about a woman who was sexually assaulted by a transgender male on a female ward, and then told incorrectly by NHS staff that it was impossible, as there were no males present on the ward. The case had plenty of pegs and was given official status by being taken up by Baroness Nicolson. There’s a very abbreviated list of missed health stories at the bottom of this submission and we can supply links to the other outlets that covered them, and dozens more, if required.

Trans women may be banned from women's NHS wards October 3 2023

We will use this as as sample piece to highlight some of the issues with BBC coverage.

‘Transgender people may be banned from single-sex hospital wards under plans to restore "common sense" in the NHS, the health secretary says.’

The framing and headline style is a) around trans rights b) focussed on exclusion. It could be framed as a) women’s rights and b) privacy and safety - this would be equally valid. But the BBC’s framing always gives primacy to trans rights.

Suggested edit, to be strictly impartial: ‘Hospital patients may be guaranteed single sex wards in new NHS transgender guidance’

‘NHS guidance issued in 2021 said trans people may be placed on wards according to the gender they identify as.’

The perennial problem with using ‘gender’ to mean both ‘gender identity’ and ‘sex’.

Suggestion to ensure it is fact-based and clear: ‘NHS guidance issued in 2021 said patients might be able to self-identify onto wards for the opposite sex’

‘But Cleo Madeleine, a spokesperson for the trans-led Gendered Intelligence charity, said: "It's disappointing’.

Cleo is male, but the reader is not told. When a male gives his opinion on males self-identifying onto female wards, this should be made clear. Suggestion: ‘Cleo Madeleine, who is male and identifies as female, said..’

‘The change would stop that with trans people given their own rooms and areas’

Again the exclusionary framing, with trans people as the focus. Those who have been campaigning for this are largely women, and it is due to women’s experiences of being assaulted, their loss of privacy, and the inhibition of their recovery by stress. They don’t get a mention.

Suggestion: ‘The change would mean wards would be male or female only, and people who identify as trans could be given separate rooms and areas’.

‘But doctors have questioned whether there are the facilities available to achieve that.’

The first response is negative. It could have been a reaction from women’s groups.

Suggestion: ‘Women’s campaigners welcomed the move but some doctors questioned whether it was viable’

‘And the move would have to meet the legal threshold set by the Equality Act’.

The second reaction also casts doubt on the decision, and suggests it might breach the law. Note that this is after the EHRC issued its guidance on legitimate reasons for single sex spaces, explicitly making clear that reasons of ‘privacy and dignity’ are fully in line with the EA 2010, as well as safety.

In all there is one voice welcoming the move, there are two voices criticising the move, and two other inserts casting doubt on whether the move is legal and viable. It’s not balanced.

Notice also the complete exclusion of relevant data. This is tremendously important. The BBC routinely deploys relevant data in its copy from studies or FOIs - naturally - for example its own FOIs on trangender waiting lists. Relevant data has been omitted here: what’s more, it looks deliberate, because two major pieces of work had been produced in April and May that year on hospital sexual violence.

In April 2023 the University of Reading found that more than 6500 rapes and sexual assaults had been reported in hospitals in England and Wales over the previous four years. These were numbers retrieved from FOIs to police. In May an investigation coordinated by the BMJ, Guardian and the BBC’s File on Four found that there had been more than 35,000 incidents of sexual misconduct or violence from in the previous four years. Here’s the BBC File on Four link. None of this was niche: it had reached the Daily Mail in July.

Why was this data excluded? It would be very natural to look at and report why single sex wards are important and desired, in an article about single sex wards, especially when the data is up to date and published by authoritative sources, including the BBC itself.

It’s because for the BBC this is not a story about single sex wards, it’s about trans people. This is the framing that dominates the BBC approach across the board, and leads it down the path of bias. If any story touches on trans people, the framing is around their experience, with their reaction in mind. This framing means the BBC will struggle with making any connection, in any story, however implied, and however relevant the information is, between gender affirmation and the risk of sexual violence. It’s uncomfortable, yes: and the BBC’s defence will be that there is nothing in the data to suggest that sexual violence is connected to trans identities.

Whether or not that is correct (and there is separate data to show that it is not correct) the BBC’s defence alone will betray its default framing. This story is not just, or even primarily, about trans identities: it is about about single sex wards, and women, and the reasons for single sex wards. The data is relevant and sound. It’s not the BBC’s job to hide uncomfortable facts, but these are the facts and they should not be excluded from a story about single sex wards and women.

In this case, the BBC framing of stories around a central ‘trans’ focus means that even when large and respectable bodies of highly relevant evidence are available from academics and outlets such as the Guardian, the BMJ and File on Four, they will be ignored and excluded.

This point about framing is crucial - it drives story pitches and commissions, the type of correspondent used, the type of contributor the BBC bids, the type of evidence it selects, the language it deploys. It’s not as simple as ‘failure to include both sides’. We know that there are senior BBC people who acknowledge that there is a problem. But this framing is the reason why bias keeps pulling the BBC back.

Suggestion: Primarily, acknowledge the problem. Editorial leaders should ask for voices in meetings that disagree, and force themselves to play Devil’s Advocate - perhaps even against themselves. Encourage discourse that removes the fear of expressing sex realist views within the BBC. Make clear that diversity of opinion is welcome. Make clear to activists that they have to comply with BBC editorial principles.

Finally - pre-Cass, the further pieces we bring to your attention as an example of selective bias and extreme focus on trans-identified males and waiting lists are these:

Why are transgender healthcare waiting times so long? February 2024

Life on a transgender waiting list March 2024

Take the second piece: this was a stunningly tone deaf article covering the personal journeys of four middle-aged trans men, written in excessively affirmative langage. There was also a chunky TV piece.

Male transitioners have been generously reported by the BBC over the last decade, with no shortage of ‘lived experience’. The choice of this subject (waiting lists) and the contributors (all middle-aged to elderly white men) absorbed significant BBC resources at a time when it was refusing to cover among other stories:

• the personal journeys of medical detransitioners

• women having to share spaces in health care settings

• women who were being declined treatment because they did not want a male trans-identifying HCP

• women having to accept treatment from male trans-identifying HCPs when they wanted a female

• women being accused of transphobia for requesting same sex care

• the health disbenefits of medical transition

• the abrupt rise in young female transitioners and the reasons for that

• the leak of the WPATH files

• the social transitioning of children by schools without the parents’ knowledge

• the large numbers of children with autism within the transgender patient demographic

• medics warning of a growing medical scandal

• multiple whistleblowers from ‘gender identity’ services

• the problems caused by changing sex on medical records

• concern at the consent of very disabled and elderly people to opposite sex care

We do have a long list of links from other outlets of dozens of stories the BBC failed to cover during this period. We can make it available. However this is as much as we will send now on health, sex and gender. We think the examples we’ve given offer a very clear picture of how the BBC frames the story. These aren’t small issues of language: the BBC must shift its entire perspective to one that is fact-based and thoroughly impartial.