NHS bosses are to blame for failures in treating trans children, says Dr Hilary Cass

Dr Hilary Cass said in her review that gender medicine for children and young people is built on ‘shaky foundations’ – PA

NHS leaders are to blame for the failures in treating trans children, Dr Hilary Cass has said.

The paediatrician who led the review into NHS transgender health care services said those in charge had “ducked their responsibility” to the children they were supposed to care for.

Dr Cass said accountability for the failings lay with several NHS organisations and “professional leadership”, in an interview with the New Statesman.

The Tavistock transgender clinic was closed down after Dr Cass found it was ‘not safe’ – PETER NICHOLLS/REUTERS

The former president of the Royal College of Paediatrics and Child Health refused to be drawn on whether there should be a public inquiry into the controversial Tavistock gender clinic, but said there was “a shared responsibility” for the failings.

“It partly sits with the trusts that were seeing the young people, [and] to some degree with NHS England, but also professional leadership,” she said.

“I think that some professional organisations have ducked their responsibility in ensuring that everyone working in this field… including in secondary care, treated these young people as they would any other.”

The trusts in question include the Tavistock and Portman in west London, where the gender clinic for children was based, and the University College London Hospital and Leeds Teaching Hospitals, whose endocrinologists – doctors specialising in hormones – prescribed puberty blockers after being referred by the Tavistock.

Medical interventions

The Cass Review was steadfast in its findings that there was a lack of evidence to support medical interventions, including the prescribing of blockers and cross-sex hormones to children and young people up to the age of 25.

The interim report by Dr Cass, published in 2022, led to the NHS banning puberty blockers for under-18s outside of a yet-to-be established clinical trial from last month.

The review found a lack of long-term data on what had happened to children prescribed the drugs and called for a more holistic approach to their care, after the report revealed accounts of gender-questioning children having mental health problems, learning disabilities, neurodevelopmental conditions such as autism, or being confused about their sexuality.

It raised serious questions as to how so many children had been given controversial drugs on the NHS, which requires the highest standards of care, regulation and evidence than in any other area of health care.

The review also revealed that warning signs had been ignored by leaders, despite evidence of children not improving or deteriorating after medical intervention.

Lack of questioning among clinicians

Patients questioning their gender had to be referred to an endocrinologist to receive sex-changing drugs because the Tavistock’s psychologists were unable to prescribe them.

Dr Cass questioned why these doctors did not reflect on what they were doing. “I would have expected them to pause for thought at that point and consider whether this was the best course of action,” she said.

“[Clinicians] see some young people who seem to improve, and that encourages them to go on, but they were also aware that some young people were actually getting worse.

“And so, yes, I would have expected at that point that the team might have questioned whether this was the right treatment for that wider group.”

Responding to criticism

Dr Cass also hit back at the criticism she had received from activists attempting to undermine her report by lobbying officials with false information.

Her team published an official response to claims, from groups including the charity Stonewall, that the systematic evidence review threw out all but two studies on the effects of puberty blockers and hormones on young people.

Dr Cass has previously said that researchers examined a total of 103 papers, eventually including 60 datasets that were deemed to be high or medium quality.

Stonewall has since apologised for briefing politicians and other public figures, while the Labour MP Dawn Butler has corrected the parliamentary record after having regurgitated the line.

Some of the most staunch criticism has come from doctors working in transgender health care, including in NHS roles.

The Telegraph revealed how Dr Walter Bouman, a consultant psychiatrist at the NHS adult transgender service, Nottingham Centre for Transgender Health, had questioned her credentials to conduct the review in an online tirade, while other senior NHS figures had refused to participate in research commissioned by the review.

“Hillary [sic] has never treated trans youth, nor is she a researcher of any significance, yet her ‘expert’ review provides supposedly ‘evidence based’ recommendations… There is a fine line between naivety, narcissism and psychopathy,” he wrote on social media.

‘Complex range of conditions’

Dr Cass, who has worked with children as a paediatric consultant for 30 years, said Dr Bouman had been “unprofessional”.

“Clearly, what he says is unprofessional,” she said.

“The thing I would pick up is his suggestion that I haven’t treated trans youth. This review is not about trans youth. This is about children with a complex range of conditions, of which gender questioning is one part, and how we provide a holistic service to support their wellbeing.”

She also said claims from Lorna Hobbs, a former Tavistock clinician, including the suggestion that researchers with links to conversion therapy were working on the review, had been “full of inaccuracies”.

“Although I’ve received aggressive and vitriolic emails and online abuse, that doesn’t particularly concern me. What concerns me is professionals spreading misinformation about this review, because that’s failing the interests of children and young people.”

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