Cass review: Gender identity services for young people ‘need to match standards of other NHS care'

Too often their care is blighted by lengthy waiting lists and being side-lined from local care services, which is leaving them having to do their own research around gender identity due to lack of expert help from NHS practitioners, according to the review by paediatrician Dr Hilary Cass.

She also warns that “noise and increasingly toxic, ideological and polarised public debate” around gender identity among young people has made the work of her review “significantly harder and does nothing” to support young people who are already feeling stressed.

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“We have to cut through the noise and polarisation to recognise that they need the same standards of high-quality care to meet their needs as any other child or young person,” said Cass.

“When you talk to these young people and their parents/carers, they want the same things as everyone else: the chance to be heard, respected and believed; to have their questions answered, and to access help and advice.

Her review also found that some clinicians “are fearful of working with gender-questioning young people”. This is despite “their presentation being similar to many children and young people presenting to other NHS services”.

To help ensure support is of the same standards of other services for children and young people the review is calling for the appointment of nominated medical practitioners with responsibility for patient safety for gender identity services.

Clinicians should also ensure they are screening young people for neurodevelopmental conditions, including a mental health assessment.

Supporting patients with “associated distress” is also needed. This support should also be available to young people’s families. Early support is also needed, adds Cass.

The charity Mermaids welcomes the report's acknowledgement that NHS services are “failing trans youth, with appalling waiting lists of more than six years” in some cases.

It adds that “virtually no first appointments” are offered for over a year and their support is increasingly impacted by “politicisation”.

“Trans youth tell us they want services which are accepting and respectful, which offer supportive spaces to explore their gender, and provide access to medical transition if and when they need it,” said the charity.

However, it is concerned that recommended improvements will be impacted by pressures "from those who seek to limit access to healthcare".  

The Children’s Society chief executive Mark Russell described Cass’s review as a “watershed moment” and an “opportunity to dismantle the existing barriers and foster an environment which places the wellbeing and safety of all children at its heart”. 

"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," he said.

Meanwhile, the British Association of Social Workers (BASW) has said it “will think carefully” about the review’s implications for social workers.

“The Cass Review presents important opportunities to get services right for these children, said BASW.

“Social workers have long worked to close the gap between medical interventions and social context.

“While the Cass Review is a crucial first step, the emphasis on a broader multi-disciplinary approach might provide important opportunities to ensure social workers can be effectively engaged with such work.”