We welcome the release today of the final report of the independent review of gender identity services for children and young people, commissioned by NHS England and chaired by Dr Hilary Cass. It is a very substantial piece of work, four years in the making, and we’ll respond more fully to its research and recommendations in due course. While some of the findings were anticipated, it is nevertheless shocking to see the facts in print.
It is clear that vulnerable children have been seriously let down by a service that was ideologically driven, and willing to make significant medical interventions without clear evidence of benefit. Normal safeguarding, and standard approaches to evidence-based care were set aside in a way that is hard to imagine in any other context.
The report calls for a holistic approach to supporting children who experience distress about their gender, and investment in mental health services. Merched Cymru has previously called for greater investment in CAMHS to allow children and adolescents to access support locally that sees them as whole persons, not focusing only on their feelings about their sex. This kind of approach is supported by Cass.
In relation to social transition, the report is clear about the need for “clinical involvement” from professionals and that “parents should be actively involved in decision making”. It reiterates that it should be seen as “an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning and longer-term outcomes.”
Schools and teachers should not be asked to make decisions with significant clinical implications. As our recent report on approaches to supporting gender-distressed children outlines, it is Merched Cymru’s view that schools which allow children to socially transition without expert input or the involvement of parents are in danger of failing in their safeguarding duties. Schools and local authorities should be looking critically at their current policies and practice.
While the Cass Review was commissioned by, and covers, NHS England, its influence will be global: it is the biggest and most thorough review of its kind so far. It also has direct implications for Wales since Welsh children experiencing gender distress are referred to the nearest NHS England specialist service at present.
In its LGBTQ+ action plan, published in February 2023, the Welsh Government promised the development of a Welsh gender service for children, and guidance for schools on how best to support children who identify as transgender.
It is vital that Welsh Government takes the evidence and recommendations of the Cass Review seriously when taking these commitments forward, including whether such a service would be in children’s best interests. Political pressure and the desire to placate activists must not outweigh due diligence. Children experiencing distress about their gender, and their families, deserve the best possible evidence-based care and support; and schools and health professionals need clear and workable guidance.
