An independent evaluation of the Cass review on child gender services

We believe that trans healthcare should be based on unbiased research that is peer reviewed. We think that the Cass review's findings have led to restrictive practices that are being directly felt by transgender children.

We feel that an independent evaluation is necessary to ensure children aren’t being unduly harmed. We think that only through a transparent process can we guarantee fair access and treatment for trans children as well as restore faith in the current NHS services.

The Independent Review of gender identity services for children and young people (the Cass Review) was a comprehensive and independent review commissioned by NHS England to make recommendations on how to improve NHS gender identity services for children and young people. The government and NHS England have made a clear commitment to implement its 32 recommendations in full.

The Cass Review is robust, evidence-based, and the most comprehensive assessment of gender incongruence in children and young people that has been produced to date. It was underpinned by a systematic review conducted by the University of York and a programme of proactive engagement. Dr Cass’ team engaged with over 1000 individuals and organisations across the breadth of opinion on this subject including trans, gender questioning young people, as well as support and advocacy groups.

Dr Cass’ team have been transparent around the methodology used throughout the Review and have made this information publicly available on the Cass Review website. The link to access the peer-reviewed systematic evidence reviews that informed the report and recommendations is available here: https://adc.bmj.com/pages/gender-identity-service-series.

The government is clear that healthcare provision for children and young people experiencing gender dysphoria and incongruence must be safe, evidence-based and clinically appropriate. Implementing the Cass Review ensures that this will happen. The government does not, therefore, believe an independent evaluation of the Cass Review would be beneficial and there are no plans for an independent evaluation.

NHS England published its ambitious two-year action plan to implement the Cass Review, which sets out how it will continue to transform and improve services, helping to tackle waiting lists while ensuring safe and holistic care. This can be found here: https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/

A summary of the progress made is included below:

NHS England has opened three new services in the North West, London, and the South West (Bristol) that offer a fundamentally different clinical model, embedding multi-disciplinary teams in specialist children’s hospitals. This model includes a nominated paediatrician or psychiatrist with overall clinical responsibility for patient safety in these services. A fourth service will open in the East of England in Spring 2025. NHS England is making progress towards its commitment for there to be a specialist children’s gender service in every region by 2026.

Investment in children and young people’s gender services in 2024/25 has more than doubled compared to 2023/24 and this will increase further as new services are established.

NHS England published a new service specification for the National Referral Support Service for Specialist Services for Children and Young People with Gender Incongruence. This means that a referral for the specialist Children and Young People’s Gender Service can be only made by an NHS-commissioned, secondary care-level paediatric service or a Children and Young Person mental health service. This will help ensure that healthcare professionals with the relevant expertise conduct the assessment and help determine any co-existing mental health or other health needs of these children and their onward care.

NHS England and DHSC, through the National Institute for Health and Care Research, continue to work together to commission an evolving children and young people’s gender research programme. In line with Cass Review recommendations this includes a study which incorporates a planned clinical trial to build the evidence of the relative benefits and harms of puberty-suppressing hormones. The study has several elements, including an observational arm covering a broader cohort of children and young people accessing specialist NHS gender services.

NHS England has started to explore with potential partner organisations the feasibility of establishing a follow through service for 17-25-year-olds. This work will require NHS England to identify a provider organisation(s) that is/are able to deliver the pathway, define a delivery model including though a proposed service specification for the purpose of public consultation, and to design the evaluation framework prior to the establishment of the service. Further development of the design of this part of care will be informed by NHS England’s systemic Review of Adult Gender Services.

This government remains steadfast in its dedication to protecting and listening to LGBT+ people. The Secretary of State has taken steps to build bridges with the LGBT+ community and stakeholders by hosting constructive, open and honest roundtable discussions, and has set out his intention to maintain an open dialogue and to continue to listen to views from all sides.

Department of Health and Social Care