RCPCH responds to publication of the interim report from the Cass Review

An Independent Review of Gender Identity Services for Children and Young People was commissioned by NHS England and NHS Improvement in Autumn 2020 to make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence.

Update, 10 April 2023: The final Cass Review is published, and we have posted our initial response

On Thursday 10 March 2022, Dr Hilary Cass published an interim report in her role as Chair of the independent review, now more often known as ‘The Cass Review’. 

The interim advice focuses on three areas:

  • Capacity, safety and standards
  • Treatment decisions
  • Data and audit 

It is important to consider the governing principles of the Review as they continue their engagement and shaping of final recommendations to NHS England: 

  • The welfare of the child and young person will be paramount in all considerations. 
  • Children and young people must receive a high standard of care that meets their needs.
  • There will be extensive and purposeful stakeholder engagement, including ensuring that children and young people can express their own views through a supportive process.
  • The Review will be underpinned by research and evidence, including international models of good practice where available.
  • There will be transparency in how the Review is conducted and how recommendations are made.
  • There are no pre-determined outcomes with regards to the recommendations the Review will make. 

You can read more about the Cass Review, including the full terms of reference on their website.  The interim report is available here.

The Royal College of Paediatrics and Child Health responds to the interim report: 

The interim report from the Cass Review published today sets out thinking on where changes could be made to the current system of care for children and young people seeking the gender identity development service (GIDS). 

The review notes that there has been a significant increase in the number of referrals to GIDS at the current sole provider for care at the Tavistock and Portman NHS Foundation Trust. Given this, it is clear to understand how the needs of children and young people can be met and the interim report is therefore welcome in helping foster a better understanding of the pathway. 

As paediatricians, we are absolutely clear that the needs of children and young people should be front and centre of how services are designed to care for them. The interim report notes that there appears to be a postcode lottery of care for children and young people across the country, which with any service – is not right. 

The interim review has also found that children and young people with gender-related distress have been inadvertently disadvantaged because local services have not felt adequately equipped to see them. It is essential that these children and young people can access the same level of psychological and social support as any other child or young person in distress, from their first encounter with the NHS and at every level within the service. Furthermore, safeguarding all children that use or are waiting to use health services will ensure children grow up and are cared for in a safe environment.

Children and young people may feel anxious or distressed by the review and Dr Cass has written specifically to this group to try to address any worries that CYP may have during this time. Dr Hilary Cass has highlighted that has this is an interim review they will publish a final report in due course.  

Regardless of where children and young people present to care or what their specific health needs are, we must all work together to ensure they receive the highest quality care, from qualified clinicians, as quickly as possible.