Following concerns raised by young people, parents, and professionals working at the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust about the services provided, NHS England commissioned an independent review to assess how children and young people with gender dysphoria were being supported by the service. 

Dr Hilary Cass, a former President of the Royal College of Pediatrics and Child Health and former Chair of the British Academy of Childhood Disability, headed the review

The review found that:

  • the single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand
  • the clinical approach and overall service design has not been subject to some of the normal quality controls that are typically applied when new or innovative treatments are introduced
  • an appraisal of international guidelines for care and treatment of children and young people with gender incongruence found that no single guideline could be applied in its entirety to the NHS in England
  • the use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.
  • for most young people, a medical pathway will not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems

Staff at GIDS reported they felt a “pressure to adopt an unquestioning affirmative approach”. This was “at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters”.

This was mirrored as the Cass Review found that “from the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations.”  

The Cass Review found that there was no apparent “standardised approach to assessment or progression through the process”. The review also identified an issue of diagnostic overshadowing. Once adolescents were “identified as having gender-related distress, other important healthcare issues that would normally be managed by local services could sometimes be overlooked”. 

This report clearly highlights that children and young people were rushed into hormone treatment without an appropriate diagnosis and involvement of the right clinicians meaning that they were misdiagnosed and started on a treatment pathway that was not right for them. Children have suffered life-changing and, in some cases, irreversible effects from the treatment they received resulting in physical and psychological damage that they will have to live with for the rest of their life.

In 2022, NHS England announced that the GIDS at the Tavistock and Portman NHS Foundation Trust was to close following recommendations from the Cass review’s interim report and the clinic was closed in March 2024. NHS England also said that puberty supressing hormones will no longer be routinely prescribed as a treatment for gender dysphoria in children and adolescents following the review’s findings that there was not enough evidence that the drugs were effective or safe.

Pogust Goodhead is pursuing legal action against the Trust over the claims of medical negligence outlined in the Cass Review.  

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