Cass Review ‘should mark a watershed moment’ – charity chief

Publication of the Cass Review’s final report on gender care for children on the NHS has been hailed as a “watershed moment” by a charity leader.

Its recommendations are an “opportunity to dismantle the existing barriers” and create a service that “places the wellbeing and safety of all children at its heart,” according to Mark Russell, chief executive of The Children’s Society.

The independent review into gender identity services for children and young people, led by Dr Hilary Cass, was commissioned in 2020 by NHS England and NHS Improvement.

It lays out 32 recommendations on how to ensure youngsters who are confused about their gender get a standard of care that is “safe, holistic and effective”.

Mr Russell added: “Children and young people exploring their gender identity still face unacceptable barriers in getting the support they critically need, highlighting that there are numerous oversights in how gender identity services are currently designed and delivered.

“The message is clear: every child, regardless of their gender identity, deserves to have the right support at the right time.

“To achieve this, it’s vital to listen to the voices of young people, allowing their experiences to drive more focused and informed services.

“This report should mark a watershed moment; an opportunity to dismantle the existing barriers and foster an environment which places the wellbeing and safety of all children at its heart.”

Professor Steve Turner, president of the Royal College of Paediatrics and Child Health (RCPCH), said the review was a “massive undertaking” and the college will “closely consider the report’s recommendations”.

“For some time now, rising demand for gender identity services across the UK has led to significant waiting times for children with gender-related distress, leaving these young people particularly underserved and vulnerable,” he added.

“It’s obvious that more resources are needed to address the holistic health needs of this young cohort.

“As a college, we are clear that the needs of children and young people should be front and centre of how services are designed to care for them.”

Among the review’s recommendations are calls for NHS England to put a “full programme of research” in place to analyse the characteristics and outcomes of every young person who uses gender services.

It also said care for youngsters with gender dysphoria “needs to be holistic and personal” and the approach to care for the youngest children should be different to that for teenagers.

Its publication comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at gender identity clinics, saying there is not enough evidence to support their “safety or clinical effectiveness”.

Going forward, they will only be available to children as part of clinical research trials.

Last month, the gender identity development service (Gids) at the Tavistock and Portman NHS Foundation Trust closed, with two regional hubs opening in London and the north of England in a bid to move away from a single-service model.

Robbie de Santos, director of campaigns and human rights at LGBTQ+ rights organisation Stonewall, said: “What is important, above all, is that trans and gender-diverse children get the quality healthcare that they need and deserve.

“The Cass Review can play a vital role in achieving this aim if its recommendations are implemented properly.

“Many recommendations could make a positive impact – such as expanding the provision of healthcare by moving away from a single national service towards a series of regional centres while recognising that there are many different treatment pathways that trans young people might take.

“But without due care, training or further capacity in the system, others could lead to new barriers that prevent children and young people from accessing the care they need and deserve.”

An NHS England spokesperson said the health service is “very grateful” for Dr Cass’ work.

They added: “The NHS has made significant progress towards establishing a fundamentally different gender service for children and young people – in line with earlier advice by Dr Cass and following extensive public consultation and engagement – by stopping the routine use of puberty-suppressing hormones and opening the first of up to eight new regional centres delivering a different model of care.

“We will set out a full implementation plan following careful consideration of this final report and its recommendations, and the NHS is also bringing forward its systemic review of adult gender services and has written to local NHS leaders to ask them to pause offering first appointments at adult gender clinics to young people below their 18th birthday.”

Prof Turner added: “It is essential that NHS England now provides the necessary additional guidance and support needed for paediatricians and the wider child health team to undertake their important role of caring for children who are gender questioning or experiencing gender dysphoria.”

Dr Lade Smith, president of the Royal College of Psychiatrists, said: “Children who are gender questioning also commonly experience mental illness.

“It is extremely important that every child who is gender questioning has timely access to services that are holistic and respond to their individual needs.”