91-666: The Independent Review of Gender Identity Services for Children and Young People (commonly, the Cass Review ) was commissioned in 2020 by NHS England and NHS Improvement and led by Hilary Cass , a retired consultant paediatrician and the former president of the Royal College of Paediatrics and Child Health . It dealt with gender services for children and young people, including those with gender dysphoria and those identifying as transgender in England . The final report
182-452: A non-departmental public body , issued a statement in April 2024 and described it as a "vital milestone" and called for all service providers to fully implement the recommendations of the review. The Scottish Government said it would "take the time to consider the findings". Humza Yousaf , First Minister of Scotland and SNP leader at the time of the final report's release, said that while
273-586: A 0–25 service for better continuity of care, and the need for additional services for those people considering detransition. The Academy of Medical Royal Colleges (AoMRC) released a statement in August 2024 in support of the report's recommendations, stating that "further speculative work risks greater polarisation", and that "our focus should be on implementing the recommendations of the Cass Review". The British Medical Association (BMA) initially called for
364-871: A Federated Data Platform (FDP). An FDP would enable every hospital trust and integrated care system (ICS) to have their own platform through which they could connect and share information between them where helpful. The FDP would build on the work done with the Covid Data Store .The contract to provide the FDP would be worth up to £480 million. Palantir are widely thought to be the frontrunners to win. This has prompted further criticism from civil liberties groups. Specialised services are those provided in relatively few hospitals and accessed by comparatively small numbers of patients, but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit
455-520: A clinical trial that is being set up by the National Institute for Health and Care Research . A new board, chaired by Simon Wessely will encourage further research in the areas highlighted in the review as having a weak evidence base. On August 7, 2024, NHS England announced a status update, including the publication of a new pathway specification for young people being considered for referral to specialist gender services. One recommendation
546-506: A delayed clinical trial into puberty blockers is planned for early 2025. The review's recommendations have been widely welcomed by UK medical organisations. However, it has been criticised by a number of medical organisations and academic groups outside of the UK and internationally for its methodology and findings. The Cass Review was commissioned by NHS England in September 2020, following
637-554: A document known as the NHS mandate which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to the mandate. In 2018 it was announced that the organisation, while maintaining its statutory independence, would be merged with NHS Improvement , and seven "single integrated regional teams" would be jointly established. NHS England
728-606: A four-tiered framework started in 1995. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy. GIDS takes referrals from all mental health care professionals, especially Tier 2 and 3 CAMHS specialists. GIDS is distinct from CAMHS as is it is nationally run, not by the local authority. However, in the CAMHS framework it sits in Tier 4, as
819-543: A further 25 being of moderate quality, and the remaining 24 being of low quality. The review concluded that the lack of evidence means no conclusions can be made regarding the impact on gender dysphoria and mental health, but did find evidence of bone health being compromised during treatment. The review disagreed with the idea of puberty blockers providing youth patients with "time to think", due to its finding that nearly all patients who went on blockers later decided to proceed on to hormone therapy. For youth assigned male at birth
910-466: A highly specialised service. In 1989 when the GIDS opened, "it got two referrals over the whole year." In 2009–10, 97 patients were referred to GIDS. By 2015–16, this had increased fourteen-fold to 1,419 and in 2017–18 to 2,519. Due to reduced funding and increased referrals, the average wait time is two years from referral to first appointment. In 2010–11, the GIDS lowered the age of prescription for
1001-601: A medical pathway is clinically indicated, wider mental health or psychosocial issues should also be addressed. Due to a lack of follow-up, the number of individuals who detransitioned after hormone treatment was unknown. The Cass Review attempted to work with the Gender Identity Development Service and the NHS adult gender services to "fill some of the gaps in follow-up data for the approximately 9,000 young people who have been through GIDS to develop
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#17327769000711092-474: A modified version of the Newcastle-Ottawa scale, and considered only one study to be of high quality, 33 moderate and 19 low quality. Overall, the review found some evidence that hormone treatment improves psychological outcomes after 12 months, but found insufficient and inconsistent evidence regarding physical risks and benefits. The review advised that there should be a 'clear clinical rationale' for
1183-536: A pause on the review's implementation while it conducted an evaluation, due to be completed by January 2025. The call prompted some opposition from doctors, more than 1,500 of whom signed an open letter to the BMA characterising their planned evaluation as a "pointless exercise". In September 2024, the BMA council voted to instead maintain a neutral position on the issue until the completion of its own evaluation. The UK's Association of LGBTQ+ Doctors and Dentists (GLADD) issued
1274-575: A previous service user and detransitioner . In December 2020 following the High Court judgement, GIDS suspended all new referrals to endocrinology. The Court granted a stay on further implementation of the judgement until 22 December 2020 or until appeals are exhausted. The judgment was overturned by the Court of Appeal in 2021. In December 2020 Dr Bell, a former governor of the Trust who was elected by
1365-543: A response to the Cass Review in November 2024. Of the 32 recommendations of the Cass Review, GLADD supported 15, said that it could support a further 14 but with provisos, could not support two, and was neutral on one. It did not criticise or appraise the methodology of the Review, saying, "We do not feel that as a committee we have sufficient expertise to do justice to such evaluation." The American Academy of Pediatrics and
1456-888: A significant increase in referrals to the Gender Identity Development Service and a shift in the service from a psychosocial and psychotherapeutic model to one that included hormonal treatment. Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, was asked by NHS England and NHS Improvement's Quality and Innovation Committee to chair an independent review with the aim of improving gender identity services for children and young people. The Cass Review commissioned several independent, peer-reviewed systematic reviews into different areas of healthcare for children and young people with gender identity issues, including gender dysphoria . The reviews were carried out by academics at
1547-644: A statement criticising the NHS England interim service specifications based on the interim report. It contested several points in the report, including the pathologizing of gender diversity, the making of "outdated" assumptions regarding the nature of transgender individuals, "ignoring" newer evidence regarding such matters, and making calls for an "unconscionable degree of medical and state intrusion" into everyday matters such as pronouns and clothing choice, as well as into access to gender-affirming care. It further said that "the denial of gender-affirming treatment under
1638-426: A stronger evidence base." However, despite encouragement from NHS England, "the necessary cooperation was not forthcoming." A systematic review assessed 23 regional, national and international guidelines covering key areas of practice, such as care principles, assessment methods and medical interventions. Most guidelines were said to lack editorial independence and developmental rigour, and were nearly all influenced by
1729-455: A team of staff with the appropriate expertise. NHS England is responsible for commissioning £19.3 billion of specialised services in 2021-2 and for dealing with Individual Funding Requests in respect of the specialist services it commissions. There are proposals to move some of this commissioning to integrated care systems . The Shelford Group expressed concerns in May 2022 about services "where
1820-492: A wider view of the patient's mental and psychosocial health." The Amsterdam University Medical Center put out a statement saying that while it agrees with the goals of reducing wait times and improving research, it disagrees that the research-base for puberty blockers is insufficient, asserting that puberty blockers have been used in trans care for decades. The Royal Australian and New Zealand College of Psychiatrists rejected calls for an inquiry into trans healthcare following
1911-754: Is a service provided by the Tavistock Clinic . Originally located at Tavistock Square in London , the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. However, it mainly focused on military psychology, including shell-shock, now termed PTSD . In 1948, with the creation of the NHS, the Tavistock Clinic launched its children's department, which developed many works by Robertson and Bowlby on attachment theory . In 1959, it opened an adolescent department and in 1967 it
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#17327769000712002-485: Is not a role that can be undertaken without appropriate clinical training. The report said that the evidence base and rationale for early puberty suppression remains unclear, with unknown effects on cognitive and psychosexual development. A systematic review examined 50 studies on the use of puberty blockers using a modified version of the Newcastle–Ottawa scale and considered only one to be of high quality, along with
2093-606: Is not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones for the treatment of gender dysphoria in children and young people" and "the Welsh Government will continue to develop the transgender guidance for schools taking account of the Cass review and stakeholder views". Citing the Cass Review findings, in August 2024 the Northern Ireland Executive agreed to
2184-483: Is that those considering social transition be seen quickly by a clinical professional with relevant experience. The update also stated that "There is no defined clinical pathway in the NHS for individuals who are considering detransition. NHS England will establish a programme of work to explore the issues around a detransition pathway by October 2024". The clinical trial to study the "potential benefits and harms of puberty suppressing hormones for children and young people"
2275-687: Is the operating name of the NHS Commissioning Board and, before that, the NHS Commissioning Board Authority. It was set up as a special health authority of the NHS in October 2011 as the forerunner to becoming a non-departmental body on 1 April 2013. It was renamed NHS England on 26 March 2013, although its legal name remains the NHS Commissioning Board. Sir David Nicholson , who became Chief Executive at
2366-428: Is their best or only option, have no hope of access to funding. Most have been waiting many months. Approximately half of these patients are at imminent risk of a catastrophic event (renal bleed or kidney failure) with a high risk of preventable death." It authorises and pays for treatment of narcolepsy with sodium oxybate by means of individual funding requests on the basis of exceptional circumstances. In May 2016
2457-487: The Endocrine Society both responded to the report by reaffirming their support for gender-affirming care for minors and saying that their current policies supporting such treatments are "grounded in evidence and science". The Canadian Pediatric Society responded to the report by saying "Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within
2548-791: The NHS Commissioning Board for England , is an executive non-departmental public body of the Department of Health and Social Care . It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the National Health Service in England as set out in the Health and Social Care Act 2012 . It directly commissions NHS general practitioners , dentists, optometrists and some specialist services. The Secretary of State publishes annually
2639-468: The NHS app was unveiled, with public backing from Matt Hancock , who presented it as the key to a radical overhaul of NHS technology. The NHS Long Term Plan set a target for all secondary care providers to move to digital records by 2024, which "will cover clinical and operational processes across all settings, locations and departments and be based on robust, modern IT infrastructure services for hosting, storage, networks and cyber security." In 2020
2730-748: The Tavistock and Portman NHS Foundation Trust closed in March 2024. Two new services, located in the north west of England and in London, opened in April 2024, which are intended to be the first of up to eight regional services. These will follow a new service specification for the "assessment, diagnosis and treatment of children and young people presenting with gender incongruence". Puberty suppressing hormones are no longer routinely available in NHS youth gender services. New patients that have been assessed as possibly benefiting from them will be required to participate in
2821-473: The Tavistock and Portman NHS Foundation Trust governance board, resigned that week after a 35-year association with Tavistock and Portman. He accused its management of having an "overvalued belief in" the expertise of GIDS, "which is used to dismiss challenge and examination." Subsequent to the Bell report it was revealed that 35 psychologists had resigned since 2016, including six psychologists who claimed there
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2912-575: The University of York 's Centre for Reviews and Dissemination , one of three bodies funded by the National Institute for Health and Care Research (NIHR) to provide a systematic review service to the NHS. The topics covered by the systematic reviews were: In the systematic reviews the report commissioned, tools such as the Mixed Methods Appraisal Tool and modified versions of the Newcastle–Ottawa scale were used to assess
3003-419: The lived experiences of patients. The interim report of the Cass Review was published in March 2022. It said that the rise in referrals had led to the staff being overwhelmed, and recommended the creation of a network of regional hubs to provide care and support to young people. The report said that the clinical approach used by the Gender Identity Development Service (GIDS) "has not been subjected to some of
3094-533: The puberty blocker drug from 15 to 10 years old after facing pressure from activists and from people may have otherwise travelled to America or Holland to obtain the drug. In 2012, the service was extended to a satellite site in Leeds. Endocrine support was also extended to Leeds Children's Hospital at the Leeds General Infirmary site in 2013. In 2015 in discussion of overwhelming caseloads,
3185-548: The 2009 Endocrine Society guideline and the 2012 WPATH guideline , which were themselves closely linked. The Cass review questioned the guidelines' reliability, and concluded that no single international guideline regarding transgender care could be applied in its entirety to NHS England. The report identified conflicting views among clinicians regarding appropriate treatment, with expectations of care sometimes deviating from clinical norms. It said that disputes over language such as "exploratory" and "affirmative" approaches meant it
3276-529: The Board deems appropriate. The direction will be in place until the end of 2020. Applications by GPs to reduce their catchment area are dealt with by NHS England. In November 2014, Mr Justice Popplewell declared that NHS England "has acted unlawfully by reason of its failure to make arrangements for the involvement of patients in primary care commissioning decisions as required by the National Health Service Act 2006". The case involved
3367-531: The Cass Review and a call to pause the implementation of recommendations. They regarded this as a "backwards step", further delaying care that already has "unacceptable waiting times". While remaining mindful of "emerging criticisms of any chosen approach", their priority is "that this group of children receive timely, holistic and high-quality care". In response to the Cass Review, the Royal College of General Practitioners in July 2024 updated its position statement on
3458-464: The GIDS July 2015 minutes record that GIDS director Polly Carmichael acknowledged overload problems and the medical director raised "escalating risk", including "the number of safeguarding and risk concerns being brought to him for advice". An external report was commissioned and delivered by Dr Femi Nzegwu. In 2016, the waiting list for the clinic had increased to nine months. In 2016, the clinic
3549-451: The High Court ordered NHS England to provide funding to treat a teenager with severe narcolepsy. The judge criticised their "thoroughly bad decision" and "absurd" policy discriminating against the girl when hundreds of other NHS patients already receive the drug. The Department of Health is also paying for the treatment of people whose narcolepsy was caused by the swine flu vaccine Pandemrix in 2009–10 by means of private prescriptions outside
3640-400: The NHS Commissioning Board to buy services from the private sector, thereby bypassing CCGs. The Exercise of Commissioning Functions by the NHS Commissioning Board (Coronavirus) Directions 2020 came into force on 20 March 2020, and were revised to widen the definition of independent providers on 27 March. The directive also allows NHS England to exercise functions normally carried out by CCGs, as
3731-463: The NHS awarded an emergency contract to Palantir Technologies for the creation of a Covid Data Store system for a statutory fee of £1. Palantir then won a £23.5 million contract with the NHS to continue with its work in December 2020. Palantir's involvement with the NHS was subject to criticism from civil liberties groups, including Open Democracy . In 2023 the NHS began a procurement process for
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3822-638: The NHS decided to close the Tavistock GIDS and replace it with regional healthcare centres, following the release of an interim report by the Cass Review on the provision of gender identity services for children and adolescents conducted by paediatrician Hilary Cass . In March 2024 the Tavistock GIDS closed, and was replaced in April with two new services at Great Ormond Street in London and Alder Hey in Liverpool, which are intended to be
3913-596: The National Health Service. In May 2022 it produced guidance that said 65 of the 154 services they commissioned were ready and suitable to be devolved to the integrated care systems . It is expected that most will be jointly commissioned with their neighbours, rather than on their own. The organisation's responsibilities include arbitration in disputes between clinical commissioning groups and NHS trusts . Gender Identity Development Service The Gender Identity Development Service ( GIDS )
4004-410: The Review as "an important part of the process of improving healthcare for children and young people" while noting "some concerns have been raised about the review, particularly in relation to accessing NHS care following private healthcare, concerns around data inclusion/exclusion and a question around a conflict of interest of one of the researchers." The British Equality and Human Rights Commission ,
4095-455: The Review started, the evidence base, particularly in relation to the use of puberty blockers and masculinising or feminising hormones, had already been shown to be weak"; and that after the examination of over 100 pieces of potential evidence, that "there continues to be a lack of high-quality evidence in this area". The report found no clear explanation for the rise in the number of children and adolescents with gender dysphoria , but said there
4186-631: The Scottish government would discuss the Cass Review with health authorities, it would leave its implementation up to clinicians. The Welsh Senedd initially voted against a motion tabled by the Welsh Conservatives Shadow Social Justice Minister to accept the findings of the Cass Review in full. Subsequently, the Senedd voted unanimously to pass an amended motion noting "NHS England has concluded there
4277-468: The UK in June 2015. The organisation was reported to be developing a strategy to support the use of personal health records in June 2015. This, it is hoped, could achieve up to £3.4 billion in annual efficiency savings by 2020. In April 2016 it published an index of digital maturity, where each of the 239 NHS trusts assessed its own "readiness", "capabilities" and "enabling infrastructure". In 2018
4368-494: The UK, although it was operated at a Tavistock and Portman NHS Foundation Trust site. GIDS was the only gender identity clinic for people under 18 in England and Wales and was the subject of much controversy. In July 2022, the NHS decided to close GIDS and replace it with regional healthcare centres, following the release of an interim report by the Cass Review on the provision of gender identity services for children and adolescents conducted by paediatrician Hilary Cass . GIDS
4459-416: The best available evidence and that no assumptions should be made about the right outcome for any given young person." The interim report said that there were "gaps in the evidence" over the use of puberty blockers. A public consultation was held and a further review of evidence by NICE said there was "not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones to make
4550-519: The decision to scrap the minimum practice income guarantee. Richard Stein, a partner at Leigh Day , said the declaration could mean that patients would have to be involved in discussions on changes to the GP contract. NHS England awarded a four-year contract to Capita to become sole provider of administrative services including payment administration, management of medical records, and eligibility lists for practitioners for GPs, opticians and dentists across
4641-475: The establishment of the Board, retired at the end of March 2014 and was replaced by Simon Stevens . One of Stevens' first acts was to announce a restructure of the 27 area teams, in response to a requirement to reduce running costs, which would reduce staffing by around 500. The 27 teams outside London were reduced to 12 in 2015. Amanda Pritchard , the Chief Operating Officer of NHS England,
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#17327769000714732-665: The evidence base underpinning medical and non-medical interventions, puberty blockers and hormone treatments, service improvements, education and training, clinical pathways, detransition and private provision. Recommendations included: NHS England responded positively to the interim and final reports. As of April 2024 they have implemented a number of measures. In response to the interim report, in March 2024 NHS England announced that it would no longer prescribe puberty blockers to minors outside of use in clinical research trials, citing insufficient evidence of safety or clinical effectiveness. The Gender Identity Development Service (GIDS) at
4823-410: The evidence for psychosocial intervention as opposed to hormonal was "as weak as research on endocrine treatment", but that the result of psychological treatment was "either benefit or no change". The report said that clinicians cannot be certain which children and young people will have an enduring trans identity in adulthood, and that for most, a medical pathway will not be the most appropriate. When
4914-580: The extension of the ban on the private sale and supply of puberty blockers to Northern Ireland. This was supported by all parties in the Executive at the time apart from the Alliance Party . The British Psychological Society said in April 2024 that they support "the report's primary focus of expanding service capacity across the country" and acknowledged that "while psychological therapies will continue to have an incredibly important role to play in
5005-452: The first of eight regional centres. Dr Polly Carmichael, a consultant clinical psychologist, led the GIDS from at least 2016. Services provided include: No surgical transition options are available through GIDS. People referred to GIDS may also contribute to NIHR studies into gender dysphoria in children. In the financial year 2018–19, 31 referrals were made for children aged 5 or under. 30 referrals were made for adults over
5096-612: The frequency of those meetings did not increase when adolescents received puberty blockers, all of which the Dutch Approach recommends. The interim report further said that GPs and other non-GIDS staff felt "under pressure to adopt an unquestioning affirmative approach" to children unsure of their gender, "overshadowing" other issues such as poor mental health. The Tavistock and Portman NHS Foundation Trust said "being respectful of someone's identity does not preclude exploration", and "We agree that support should be holistic, based on
5187-471: The guise of ' exploratory therapy ' is tantamount to 'conversion' or 'reparative' therapy under another name". The final report of the Cass Review was published on 10 April 2024. It included several systematic reviews of scientific literature carried out by University of York , encompassing the patient cohort, service pathways, international guidelines, social transitioning , puberty blockers and hormone treatments . The report states on page 20 that, "When
5278-535: The historical allocation was slow, and CCGs which were above their allocation did not suffer a reduction. From April 2016, however, CCGs with more than 10 per cent above their fair share were to receive "flat cash" – an effective reduction. This would also ensure than no CCG was more than 5 per cent below its target allocation in 2016/2017. In October 2016 it introduced the Operational Pressures Escalation Levels (OPEL) system for
5369-475: The increase. A systematic review evaluated 11 studies assessing the outcomes of social transition in minors using a modified version of the Newcastle-Ottawa scale and considered nine to be low quality and two to be moderate quality. The report said that insufficient evidence was available to assess whether social transition in childhood has positive or negative effects on mental health, and that there
5460-410: The largest budget deficits. It is intended to reduce their spending by around £500 million, and health leaders were told to "think the unthinkable". In 2022 there were seven regional teams and 10,640 full time equivalent staff. NHS England allocates funding (£69.5 billion in 2016/2017) to CCGs in accordance with a funding formula. Until 2016, progress towards the amount indicated by the formula from
5551-566: The management of operational difficulties in English hospitals, replacing the system of red and black alerts which was locally defined. OPELs range from 1 (normal) to 4 (a major crisis requiring external intervention either regionally or nationally). This is intended, among other things, to enable comparisons of trends over time and between areas. In view of the coronavirus pandemic , the Secretary of State for Health and Social Care directed
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#17327769000715642-585: The medical staff and who had produced in February 2019 a report on the methods of the GIDS, reported that he now faced "disciplinary action" from the Trust. The threats to take disciplinary action lapsed when Dr Bell retired in 2021. The Observer interviewed Bell in May 2021. In January 2021 GIDS was rated "inadequate" (the worst rating) by the Care Quality Commission. In July 2022,
5733-409: The new services, more needs to be done to assess the effectiveness of these psychological interventions." BPS president Roman Raczka commended the review as "thorough and sensitive", in light of the complex and controversial nature of the subject. He said "it will take time to carefully review and respond to the whole report" but he was sure the field of psychology would learn lessons from it. He welcomed
5824-481: The numbers and evidence base supports the planning and provision of care being done at a population size larger than a typical ICS footprint." In 2015 there was criticism of delays in deciding on a policy for the prescription of Everolimus in the treatment of tuberous sclerosis . Twenty doctors addressed a letter to the board in support of the charity Tuberous Sclerosis Association saying "around 32 patients with critical need, whose doctors believe everolimus treatment
5915-506: The prescription of hormone therapy under 18 years of age. A systematic review assessed ten studies on the efficacy of psychosocial support interventions in transgender minors using the Mixed Methods Appraisal Tool and considered only one to be of medium quality, with the remaining nine being of low quality. The review concluded that no robust conclusions can be made and more research is needed. The report said that
6006-664: The quality of the studies available because no blinded controlled studies – those usually thought of as having the highest quality – were available. The systematic reviews performed meta-analyses to ascertain the best evidence-based knowledge on their respective subjects to inform the report's findings and recommendations. In its collection of evidence, the report also carried out qualitative and quantitative research into young people with gender dysphoria and their health outcomes, carried out listening sessions and focus groups with service users and parents, held meetings with advocacy groups, and gathered existing documented insights into
6097-408: The recommendation for a consortium of relevant bodies to develop better trainings and upskill the workforce. The Royal College of Psychiatrists welcomed the report and strongly agreed with some of its recommendations. They supported the emphasis on a holistic and person-centred approach and research to improve the evidence basis for treatment protocols. They said that some of its trans members, and
6188-504: The release of the Cass Review. They characterised the Cass Review as one review among several in the field. They emphasised that, "assessment and treatment should be patient centred, evidence-informed and responsive to and supportive of the child or young person's needs and that psychiatrists have a responsibility to counter stigma and discrimination directed towards trans and gender diverse people." The Japanese Society of Psychiatry and Neurology published updated guidelines in August 2024 on
6279-594: The report states that blockers taken too early can make a later penile inversion vaginoplasty more difficult due to insufficient penile growth. The report states one of the benefits of puberty blockers is the prevention the irreversible changes of a lower voice and facial hair. The report said that many unknowns remained for the use of hormone treatment among under-18s, despite longstanding use among transgender adults, with poor long-term follow-up data and outcome information on those starting younger. A systematic review evaluated 53 studies on transgender hormone therapy using
6370-429: The role of the GP in transgender care. They advise that, for patients under 18, no GP should prescribe puberty blockers outside of a clinical trial, and the prescription of gender-affirming hormones should be left to specialists. The GCGP affirms it will fully implement the recommendations of the Cass Review. They specifically highlight recommendations for services 17–25 year olds, noting that some other fields are moving to
6461-400: The service was "not fit for purpose", as children were being prescribed experimental drugs "after a few sessions and without proper investigation of their cases[...] under pressure from transgender rights groups". Bell urged the suspension of "all experimental hormone treatment for children who wished to change gender until there was better evidence of the outcomes." Dr Marcus Evans, a member of
6552-510: The time to review the recommendations in full and said that data collected had identified a lack of confidence by paediatricians and GPs to support this patient group, which the RCPCH pledged to address by developing new training. RCPCH President's Steve Turner thanked Cass and her team for the "massive undertaking" and said they would consider the report's recommendations. In August 2024, the RCPCH acknowledged there had been some academic criticism of
6643-496: The time, welcomed the final report, saying that the report "must provide a watershed moment for the NHS's gender identity services" and committing the Labour Party to implementing the report's recommendations in full. Speaking to Sky News , Shadow Home Secretary Yvette Cooper said that Labour welcomed the Cass Review and committed to implementing all of its recommendations. The Green Party of England and Wales described
6734-836: The treatment of gender dysphoria. The guidelines considered the Cass Review, describing it as specific to the unique situation in the UK, noted criticism of the Cass Review by other international organizations, and stated that the WPATH SOC8 considered more systematic reviews. The guidelines further noted it is "self-evident" that, unless puberty is suppressed, development of sex characteristics are irreversible in AMAB individuals. The society stated they would continue to track and recommend prescriptions of puberty blockers in Japan to minors and expand to tracking discontinuations and switches to hormone therapy. NHS England NHS England , formerly
6825-503: The treatment routinely available at this time." As a result, NHS England stopped prescribing them to children. In April 2022, Health Secretary Sajid Javid told MPs that services in this area were too affirmative and narrow, and "bordering on ideological". In November 2022, the World Professional Association for Transgender Health (WPATH), along with regional groups ASIAPATH, EPATH, PATHA, and USPATH, issued
6916-518: The usual control measures" typically applied with new treatments, and raised concerns about the lack of data collection by GIDS. While GIDS initially followed the Dutch protocol , the interim review said there were "significant differences" in the current NHS approach. The report stated that children with comorbidities did not receive adequate psychological support, endocrinologists administering puberty blockers did not attend multidisciplinary meetings, and
7007-555: The wider trans community, had concerns about availability of treatments while awaiting research, said there was "a strong view that the report makes assumptions in areas such as social transition and possible explanations for the increase in the numbers of people who have a trans or gender diverse identity, which contrasts with the more decisive statements about treatment approaches", and called for direct and comprehensive involvement of those with lived experience. The Royal College of Paediatrics and Child Health (RCPCH) said they would take
7098-404: Was "over-diagnosis" of gender dysphoria and a push for early medical intervention, because "psychologists fear being branded transphobic." In February 2019, it was revealed that the National Institute for Health Research (NIHR) had announced a £1.3 million grant for a study following young people referred to GIDS, to compare mental and physical health outcomes for children referred. The study
7189-468: Was a nationally operated health clinic in the United Kingdom that specialised in working with children with gender identity issues, including gender dysphoria . The service closed on 28 March 2024 after serious concerns were repeatedly raised over a number of years by several independent NHS whistleblowers. Launched in 1989, GIDS was commissioned by NHS England and took referrals from across
7280-509: Was absorbed into the London Child Guidance Clinic. The Tavistock Clinic established GIDS in 1989. GIDS was founded by Domenico Di Ceglie, a child and adolescent psychiatrist. Child and Adolescent Mental Health Services (CAMHS) provides the NHS support for children with mental health issues. However, CAMHS is organised by local government area and thus coverage varies significantly. The development of CAMHS within
7371-424: Was appointed for each area, who is to be responsible for the implementation of the plans which are to be agreed by the component organisations. They will be "working across organisational boundaries to help build a consensus for transformation and the practical steps to deliver it". In April 2017 it introduced a capped expenditure process, applied to NHS commissioners and providers in the 13 areas across England with
7462-469: Was broad agreement for attribution to a mix of biological and psychosocial factors. The report's suggested influences included a lower threshold for medical treatment, social media-related mental health consequences , abuse , access to information regarding gender dysphoria , struggles with emerging sexual orientation, and early exposure to online pornography . The report considered a rise in acceptance of transgender identities to be insufficient to explain
7553-597: Was difficult to establish neutral terminology. Some clinicians feared working with gender-questioning young people. The report said that some professionals were concerned about being accused of conversion practices, and were likewise concerned about legislation to ban conversion therapy . The report went on to say that many professionals were "overshadowed by an unhelpfully polarised debate around conversion practices". The report made 32 recommendations covering areas including assessment of children and young people, diagnosis, psychological interventions, social transition, improving
7644-552: Was due to start late 2024 but is now delayed to early 2025. Conservative Prime Minister at the time Rishi Sunak said that the findings "shine a spotlight" on the need for a cautious approach to child and adolescent gender care. In their manifesto for the 2024 United Kingdom general election , the Conservatives promised to implement the Cass Review recommendations. Wes Streeting , the Labour shadow Health Secretary at
7735-434: Was intended to tackle "deep rooted and systemic issues that previous interventions have not tackled across [a] whole health and care economy". In 2016 it organised the geographical division of England into 44 sustainability and transformation plan areas, with populations between 300,000 and 3 million. These areas were locally agreed between NHS Trusts , local authorities and clinical commissioning groups (CCGs). A leader
7826-481: Was promoted to Chief Executive on 1 August 2021. NHS England produced a planning document – the Five Year Forward View – in October 2014 which envisaged development of new models to suit local needs. In conjunction with the other central regulators, the organisation established what is called a "success regime" in south and mid Essex, North Cumbria and north east and western Devon in June 2015. It
7917-465: Was published on 10 April 2024, and it was endorsed by both the Conservative and Labour parties. The review led to a UK ban on prescribing puberty blockers to those under 18 experiencing gender dysphoria (with the exception of existing patients or those in a clinical trial). The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust closed in March 2024 and
8008-439: Was replaced in April with two new services, which are intended to be the first of eight regional centres. In August, the pathway by which patients are referred to gender clinics was revised and a review of adult services commissioned. In September, the Scottish government accepted the findings of a multidisciplinary team that NHS Scotland had set up to consider how the Cass Review's recommendations could best apply there. In England
8099-453: Was the subject of a Channel 4 documentary programme, told from the point of view of two satisfied trans children and their families. In November 2018, the parents of patients complained in a letter to the Trust board about the alacrity at which diagnoses were rendered, leaving them unable to intervene in these "life-altering decisions". This led to the commissioning of an internal report by Dr David Bell, which concluded in February 2019 that
8190-577: Was to compare the effectiveness of different interventions, including psychological, endocrinological, pharmaceutical and alternative interventions. In July 2019, the Tavistock Centre was flooded, which temporarily affected the IT servers at the clinic. In October 2019, a lawsuit was launched against GIDS by the mother of a patient at GIDS and Sue Evans, a nurse who formerly worked there. Later, Evans passed their role as complainant to Keira Bell,
8281-442: Was weak evidence for efficacy in adolescence. It also said that sex of rearing seems to influence gender identity, and hypothesised that early social transition may change the way a child's gender identity develops. The report classified social transition as an "active intervention". It also advised caution in approaching social transition, and stressed the need for clinical involvement in determining risks and benefits, saying that it
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