Cass Review findings of weak evidence in gender care ‘scandalous’ – Streeting

The Cass Review

Findings that children’s gender care in the NHS has been based on weak evidence have been branded “scandalous” by the shadow health secretary who told of his anger that adult gender clinics had refused to take part in research.

Wes Streeting called The Cass Review, which said children have been let down by a lack of research and evidence on the use of puberty blockers and hormones, an important piece of work which had raised serious concerns.

Prime Minister Rishi Sunak has said the findings “shine a spotlight” on the need to “exercise extreme caution” when it comes to gender care for children.

The report, first commissioned in 2020, concluded that gender care is currently an area of “remarkably weak evidence” and young people have been caught up in a “stormy social discourse”.

Research by the University of York, carried out alongside the report, found evidence to be severely lacking on the impact of puberty blockers and hormone treatments, while the majority of clinical guidelines were found not to have followed international standards.

Asked about Dr Hilary Cass’s report, Mr Streeting told The Sun’s Never Mind the Ballots show: “I think she’s done a really important piece of work but I think it does raise some serious concerns that are pretty scandalous.”

He pledged that a Labour government would take an “evidence-led approach to this” area of healthcare in future.

He said: “I think we’ve got to ask ourselves, why is it that we’ve seen medical interventions that have been given on the basis of very weak evidence? How is it that clinicians have been silenced or afraid to come forward?

“Why is it that a group of young people who are extremely vulnerable are waiting years to access treatment?”

With the publication of the review, it emerged that adult clinics had refused to support a study on outcomes for approximately 9,000 young people who have moved over the years from the now-shut gender service at the Tavistock trust into adult gender dysphoria clinics.

Dr Cass said it would have been a “world-leading opportunity” to add to the evidence base and described it as “hugely disappointing” that they had decided not to take part.

Six of the seven adult clinics declined to support the study, with reasons for not doing so including ethical considerations and concerns about funder motivation and political interference.

Mr Streeting said he was “pretty angry” at the revelation, adding: “I want to send a clear message to them (the adult clinics) that, under a Labour government, there will be accountability for that, you’re not going to get away with it.”

The recommendations in the lengthy and long-awaited report, which was first commissioned in 2020, have prompted NHS England, which had already stopped puberty blockers being given to under-16s, to announce a review into the use of hormones.

It has also written to local NHS leaders to ask that they pause first appointment offers at adult gender clinics to young people before their 18th birthday, as it also intends to carry out a major review of these services.

Among her 32 recommendations, Dr Cass called for a “follow-through” service for 17 to 25-year-olds rather than this “vulnerable” group going straight into adult clinics, saying teenagers are “falling off a cliff edge” in their care when they reach 17.

Her report said gender services should operate “to the same standards” as other health services for children and young people, with “a holistic assessment” of referrals, including screening for neurodevelopmental conditions such as autism, and a mental health assessment.

She said “ideology on all sides has directed care, rather than care being directed by normal principles of paediatrics and mental health”, as she spoke ofprofessionals feeling “anxious” about what the appropriate course of action to take has been when caring for children.

All young people using gender services should from now on be asked to be part of research, Dr Cass’s report said, in a bid to build a better picture of the long-term outcomes for patients.

Mr Sunak told LBC he believes the report is “very supportive, I think, of the direction of travel we’ve (the Conservative Government) taken, particularly in our schools where we’ve issued guidance recently so that teachers know how to deal with these things”.

Dr Cass said that “for the majority of young people, a medical pathway may not be the best way” to address their needs.

The Children’s Society has called for the report to “mark a watershed moment” in fostering an environment “which places the wellbeing and safety of all children at its heart”, while the Royal College of Psychiatrists said all gender-questioning children must get “timely access to services that are holistic and respond to their individual needs”.

In a letter to Dr Cass, NHS England officials said a planned review of adult services will be brought forward and it is understood it will be a Cass-style review led by an independent expert.

Mermaids, a transgender youth support charity, said the “current system is failing trans youth” and called for the NHS to “resist pressures from those who seek to limit access to healthcare” and instead “act urgently to provide gender services which are timely, supportive and holistic”.

NHS England has said it will “set out a full implementation plan following careful consideration of this final report and its recommendations”.

Two new regional hubs for children’s gender care opened earlier this month following the closure of the Gids (Gender Identity Development Service) at the Tavistock and Portman NHS Foundation Trust.

A spokesperson for the new London-based regional service said it would be “closely following NHS England guidelines informed by Dr Cass’s interim report”.

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