You may have seen that Dr. Hilary Cass has now published the final report of her review of NHS gender identity services for children and young people in England.

We’re still reading and digesting the report, but wanted to share some initial thoughts.

Overall, we’re pretty worried about what the report might mean for trans young people’s access to healthcare in England. We think it’s important to engage with the report thoroughly and thoughtfully though – and we’re sure that our thinking will develop as we’ve had more time to do so.

Some points of agreement:

We totally agree with Dr. Cass that children and young people who are trans, or questioning their gender, should be entitled to the same level of healthcare as all other children and young people. And we very much agree that this has not been and isn’t currently the case.

Often this is because children and young people are stuck in an impossible situation – specialist services are under-resourced, and cannot provide timely support and care to people, and “mainstream services” often lack the confidence to provide care to young people who are trans, or questioning their gender. This is true across the UK. So we think that some of the recommendations about making more services available outside of specialist settings, not exceptionalising people exploring or experiencing distress around their gender identity, and having a much bigger range of healthcare practitioners available and able to work with and support these children and young people, sound like they would be a very good thing, and something we would also support happening in Scotland.

We also agree that more evidence about trans children and young people’s (and indeed adults’) healthcare outcomes is needed. And we would always support more collaborative and ethical research about this, in the hope that it could be used to improve the care that people receive.

So why are we worried?

In particular, we’re concerned that the review seems to take as its starting point that the best outcome would be that a child or young person doesn’t transition. We totally accept that Dr Hilary Cass does agree that transition may be in some people’s best interests, but the strong impression given by the report is that this should be the last resort.

We think that the only reasonable starting point is that the best outcome for any child or young person is totally individual to them. We have always been clear that we absolutely do not think that all children and young people exploring or questioning their gender identity, or indeed even experiencing distress about it, will necessarily come to understand themselves as trans, or to transition. But some will. And if healthcare services are designed on the premise that transition is the least desirable outcome, and to exhaust all other alternatives first, then that could be hugely costly to those trans children and young people for who transition is the right option.

And it is that impression – that transition is seen as a last resort – that leaves us worried about the review and recommendations, and what their implementation might mean.

A smaller note on how or if this applies in Scotland:

The Scottish Government has said that they will consider the findings of the Cass review, and how they might apply to NHS services here. We’d very much expect them to do this – it is a significant piece of work, and it should be engaged with seriously.

We have separate gender identity services, including a children and young person’s service, overseen by NHS Scotland. The Sandyford Children and Young Person’s Service has always operated differently from the (former) Tavistock Gender Identity Development Service in England. So it’s not possible to just copy and paste the recommendations from the Cass Review into a Scottish context.

Work is also currently ongoing to improve gender identity services in Scotland, including work to develop a service specification for a nationally commissioned Children and Young Person’s Service. And there is work happening to improve the evidence about trans people’s health outcomes being funded by the Chief Scientist’s Office, which will hopefully be published within the next year. These are just two of the commitments in the Scottish Government’s NHS gender identity services: strategic action framework.

We very much hope to continue to be involved in the progress of this work, and to see serious improvements in healthcare provided to trans people across Scotland, whatever their age.

And finally:

We’re sending our thoughts to all today across the UK who are feeling worried about the report’s publication, the news coverage around it, and what it might mean for the future. If you need to talk to someone, you can reach out to:

LGBT Youth Scotland’s Live Chat support: https://lgbtyouth.org.uk/get-support/live-chat/

LGBT Health and Wellbeing’s LGBT+ Helpline: https://www.lgbthealth.org.uk/services-support/lgbt-helpline-scotland/

Gendered Intelligence: https://genderedintelligence.co.uk/services

Mermaids: https://mermaidsuk.org.uk/helpline-support-services/

LGBT Switchboard: https://switchboard.lgbt