The independent review was commissioned by NHS England and published on Wednesday 10 April
BY DIVA STAFF, IMAGE VIA PEXELS
Today (Wednesday 10 April) a 400-page report into England’s model of care for trans youth under the age of 18 was published. The independent review was commissioned by NHS England back in 2020 and was headed by Dr Hilary Cass to address to rise in referrals to the country’s only youth gender clinic.
These are some of the system changes the report calls for…
The Cass Review proposes a major expansion in care for trans, non-binary, gender diverse and gender questioning youth and young people.
Today’s report builds on ecommendations made in an interim report which was released in March 2022, and called for a decentralised approach to care provision in England in the form of regional hubs. The final Review proposes a distributed care system with regional hubs, and is clear that care for trans and gender diverse children should not only be provided in a hospital setting.
It has also proposed an urgent referral pathway for younger children and a “follow-through” service for 17-25 year olds that would transition patients to adult gender clinics.
The report recommends that all young people referred to the new services should be assessed to “inform an individualised care plan”, and that this should include screening and care for conditions such as autism, depression, anxiety and more. It is not clear how this will be achieved when Child and Adolescent Mental Health Services and and assessment and support services for autistic children and young people are already stretched to breaking point.
Finally the Cass Review proposes establishing a major long term research programme into care for trans and gender questioning children and young people.
All of these changes require a very substantial investment and a major long term change programme taking place.
But right now waiting lists are inhumanely long and it is clear that this current system is failing trans youth.
What are some other key findings from the review?
A lot of The Cass Review focused on evidence for care approaches. The report states that the evidence base on all forms of treatments for trans and gender questioning youth is weak – whether this is medical care such as puberty blockers and cross sex hormones or psychosocial interventions.
It maintains NHS England’s position that puberty blockers should not be available outside of the context of a proposed clinical trial (which does not yet exist). In practice this means that there will be no new referrals for a child or young person to be assessed by endocrine services until the trial is set up.
It proposes that masculinising/feminising hormones should continue to be available for 16-17 year olds, but should be prescribed in exceptional circumstances with “an extremely cautious” clinical approach.
How have people responded to The Cass Review so far?
Despite only being published this morning, it has already been weaponised by anti-trans groups and been met with sensationalised coverage. Within the review Cass addresses weaponisation stating: “Narratives around detransition and regret have become increasingly fraught and weaponised in the time since the Review started. Initially, the Review heard from those who strongly support gender-affirming care and contested that cases are vanishingly rare and are mostly a response to lack of acceptance and minority stress.”
In response to this sensationalism, Amnesty International UK and Liberty released a statement: “All children have the right to access specialist effective care on time and must be afforded the privacy to make decisions that are appropriate for them in consultation with a specialist.
“This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people.
“It’s concerning that sections of the media and many politicians continue to spread moral panic with no regard for the possible consequences for trans people and their families.
“The negative rhetoric by the Government about the dangers of so-called gender ideology, healthcare for young trans people, as well as the push against LGBT-inclusive sex and relationship education is harmful and extremely damaging. It is no different from the ultra-conservative and evangelical groups pushing for discriminatory laws targeting trans people in the United States.
“Scapegoating trans people is harmful and dangerous. The Government should protect everyone’s human rights rather than exploit the diverse experiences of trans people to score points.”
Gendered Intelligence is a charity organisation that specialises in trans awareness training and education and is dedicated to making life better for trans people in the UK. Earlier this week they released an Instagram post warning that the The Cass Review report was due to come out. They wrote: “We know there will be lots of coverage and lots of debate about what this means for trans young people. We want to properly understand the report before we respond.” It takes a long time to fully process a 400-page document of any kind. So we are likely to see much more in-depth reactions in the coming days and weeks.
Mermaids, an organisation that focuses on offering support to trans+ youth and their families, has released a statement in response to the review. This can be read in full here.
The statement opens with: “Everyone deserves access to timely, supportive and holistic healthcare. However, across all of the UK, the NHS is failing trans youth, with appalling waiting lists of more than six years, virtually no first appointments offered for over a year, and increased politicisation of the support offered to children and young people.”
It goes on to describe how The Cass Review recognises the current system is failing trans youth. Mermaids have also shared their appreciation that the voices and experiences of trans youth appear to have been heard and respected and that Dr Cass calls for trans youth and their families to be “treated with compassion and respect.”
“However, we are concerned that some of the language in the report is open to misinterpretation and could be used to justify additional barriers to accessing care for some trans young people in the same way the interim report has been.” Mermaids went on to confirm that they will publish their full analysis of The Cass Review in due course.
If you or your young person need support today you can contact Mermaids’ helpline team that is open Monday – Friday, 9am-9pm on 08088010400.
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