“The current model is not sustainable and another model is needed”: Interim Report of Cass Review welcomed by families with transgender-identified children, reports Gary Powell

The independent Cass Review of gender identity services for children and young people this morning published its interim report to NHS England. The Report does not include the Review’s final recommendations, though it pulls no punches with its suggestion that the current model of NHS child gender services is “not sustainable” and that there is a need for “normal quality controls”.

The Report has been strongly welcomed in a statement issued by the Bayswater Support Group (BSG), which was set up to help families where a child or young person has come to identify as transgender.

The key points of the Cass Report, divided into “context” and “moving forward”, have been published on the web page from which the 112-page interim report can be downloaded.

In its statement, BSG “welcomes the Independent Cass Review into NHS child gender services, whose interim statement today says that the ‘current model is not sustainable and another model is needed.’” BSG affirms that the Report also recognises a lack of “normal quality controls that are typically applied when new or innovative treatments are introduced”. 

BSG highlighted the lack of accurate and balanced evidence identified by the Cass Report: “It has become increasingly clear that a 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,” and welcomed the recognition of there being a wide disparity in the definition and treatment of gender dysphoria, with clinicians both within and without GIDS reporting pressure to conform to the “affirmative model” of care and fearing negative consequences if they do not do so.

The group welcomed the Report’s assertion that “Consistent data must be collected by clinical services, for both audit and research purposes so that knowledge gaps can be filled, alongside an active research programme,” and the identification of a lack of “normal quality controls that are typically applied when new or innovative treatments are introduced”, drawing attention to the fact that the largest group of children affected – teenage girls – has the least data on outcomes, because ”the rapid increase in this subgroup only began from around 2014-2015”.

The family support group drew attention to the Report’s recognition of the negative impact on children and young people caused by currently prevailing practices, flagging up the following elements of the Report: “Social transition is not a neutral act”; reference to “The important role of schools and the challenges they face in responding appropriately to gender-questioning children and young people”; “We have heard from young lesbians who felt pressured to identify as transgender male, and conversely transgender males who felt pressured to come out as gay rather than transgender” [sic]; and reference to the distress associated with societal stereotyping and pressure to conform to unrealistic expectations of gender on social media.

The identification by the Review of serious safeguarding concerns was also welcomed by BSG: “There do not appear to be consistent processes in place to work with other agencies to identify children and young people and families who may be vulnerable, at risk and require safeguarding”; “Children are “advised not to admit to previous abuse or trauma, or uncertainty about their sexual orientation”.

The BSG statement affirmed identification in the Report of serious shortcomings in the current service model, including a recognition of a lack of regulatory accountability and the requirement that relevant medical experts, such as endocrinologists, paediatricians, and psychiatrists, must by default be part of the multidisciplinary team in future; that GPs are reporting pressure to prescribe hormones and puberty blockers to children who have already started taking them under prescription from private providers; and that there is inconsistency in the assessment process, resulting in an unusually broad range of final outcomes.

The Bayswater Support Group draws on a wealth of experience: “Our support group was set up in autumn 2019 by the parents of children with adolescent-onset gender dysphoria and has over 400 members. We advocate for an evidence-based approach to treating adolescents and young adults, which explores all options before resorting to irreversible medications and surgery.”

“Parents are concerned about the extraordinary rise in the numbers of children presenting at GIDS, the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust. GIDS has shown a 4200% increase in the numbers of girls presenting at clinics with gender dysphoria in recent years. Parents are also disturbed by the research that shows roughly 80% of children grow out of gender dysphoria if they do not have medical intervention, however studies following the recent use of puberty blockers show that 0-5% of children who take puberty blockers desist.”

GIDS is currently the only specialist service in England that accepts children referred for gender identity issues. Many of BSG’s children are current and former patients at GIDS or are on the waiting list following a referral.

Very serious concerns have been voiced in the lesbian and gay community and among its supporters concerning the highly disproportionate number of lesbian and gay children and young people being referred to GIDS after encountering LGBT+ gender ideology online or at school, which may provide a very tempting alternative route to young people who are struggling to come to terms with their sexual orientation.

BSG’s most recent survey on the issue indicated that at least half of the trans-identified children and young people in its member families had come out as lesbian or gay before being exposed to transgender ideology.

A declaration of transgender identity by a same-sex oriented young person may be an attempt to avoid the journey of self-acceptance often associated with coming to terms with being lesbian or gay, given that trans-identification is taken to imply heterosexuality with a mismatch between “gender” and physical bodily reality. Given the current high social status and power associated with transgender identity, it can also provide a route out of homophobic bullying into a new protected and popular place in the social hierarchy for marginalised, insecure lesbian and gay teens.

There are also serious concerns regarding the high number of high-functioning autistic and gender non-conforming children and young people who are becoming drawn into transgender identification.

“This interim statement gives us hope that our children will in future receive care that is based on scientific evidence and accurate data, rather than on ideological views,” BSG declared. “We welcome the move to regional centres, where our children will receive holistic assessments. At the moment, we find as soon as our children announce a trans identity, their gender issues become the focus with comorbidities pushed to the background. Our children deserve the same level of healthcare as any other child.

“Our parents currently encounter a mixture of views from CAMHS professionals. Some areas push immediate unquestioned affirmation of the child, while others are willing to be more cautious. We support the move to a standardised approach to training, which should remove these inconsistencies.”

The Bayswater Support Group provides an important voice to often beleaguered parents whose children have been badly served by the current NHS service – and whose concerns have been vindicated by the Cass Review Report published today. The accounts shared below, from four different BSG parents, provide an indication of the harrowing experience inflicted on their children and, by extension, on their families:

“My son was completely groomed online and via peers what to say to get his CAMHS psychiatrist to make a GIDS referral.  It bore no relation to his actual childhood which was untroubled by gender issues.  He also omitted all the details on his mental health issues relating to being bullied due to neurodevelopmental issues, affecting his ability to get on with his peer group. I am very glad that this report recognises that there must be a far more comprehensive assessment process instead of just taking everything at face value.”

“It’s terrifying enough that our GP so quickly referred our daughter to GIDS, and our school socially transitioned her without our consent, but on top of that they did so without accurate, balanced evidence that these approaches would benefit her long-term mental and physical health.”

“My teen daughter never experienced any gender issues as a child, but following extreme bullying when she moved to a new school, adopted a trans identity. All the adults around her quickly jumped to affirm her as a boy despite our concerns and tried to pressure us to follow suit. I am so relieved that The Cass Review recognises this is an under-researched area and that social transition is not a neutral act.”

“My daughter identified as trans from the age of 13 until realising she had made a mistake at 17. She now considers herself female and lesbian. I believe our refusal to socially transition her and our rejection of a referral to GIDS helped keep her options open and avoid potentially irrevocable medical interventions. I am delighted that Cass recognizes the multifactorial nature of gender dysphoria and that detransitioners are overlooked and unsupported in the current system.”

For more information about the Bayswater Support Group, or to make a donation, please visit their website.

Gary Powell is a gay man and has been active in gay politics since 1980. He is the Research Fellow for Sexual Orientation and Gender Identity at the Bow Group and the European Special Consultant to the Center for Bioethics and Culture.