NEWS: NHS Scotland reviews gender identity care

As reported by NHE, NHS Scotland’s review team has submitted findings to the Scottish Parliament, recommending enhanced care models for gender identity services based on the Cass Review

The multidisciplinary team that was established to examine how the Cass Review could apply across NHS Scotland has submitted its findings to the Scottish Parliament following the conclusion of the general election.

The team considered all 32 of the recommendations from Dr Hilary Cass’ Independent review of gender identity services for children and young people for NHS England.

Overall, the team found the majority of recommendations were at least partially applicable to the Scottish health service, with six found to be not applicable.

Among other things, the multidisciplinary group of reviewers recommend that a lead senior clinician (preferably a consultant) should take overall responsibility for each young person’s care, with each care plan including a full assessment of the child’s needs into account — i.e., physical, social, psychological etc.

Puberty blockers should be paused until further clinical trials can be undertaken, although NHS Scotland will maintain participation in the upcoming UK study.

Work to design a regional service for children and young people should begin immediately, with service delivery as locally as possible. They should also be based in children’s health services, with strong links between secondary and specialist services.

Scotland’s chief medical officer, Sir Gregor Smith, wrote a letter to the convener of the Health, Social Care and Sport Committee on the matter.

He said: “We believe we need to expand capacity of the gender identity service for children and young people in Scotland through a distributed service model, based in paediatric services and with strong links between secondary and specialist services.”

He added that the Scottish service model should be developed in the same way any other paediatric services are.

“Service planning mechanisms in the NHS in Scotland should assess and make recommendations to Health Board Chief Executives on service and staffing models,” wrote Smith.

“Applying the principle ‘as local as possible and as national as necessary’ to these services, as with other NHS service planning, will help ensure that the best care can usually be delivered close to home by local universal and specialist services with prompt access to expert input where necessary.”

Scotland’s health secretary, Neil Gray, said: “The Scottish Government welcomes the multi-disciplinary team’s report, which has carefully considered the Cass Review’s recommendations and how they apply to Scotland.

“The conclusions of the report will now be considered and used to improve gender identity healthcare for children and young people.”

Sir Gregor Smith also recommends that access to services should be through a GP after an initial assessment and much of the care should be normalised within the existing paediatric service infrastructure, supplemented by training and specialist staff.

The recommendations were informed by the medical directors from NHS Lothian and NHS Greater Glasgow and Clyde, as well as other expert professionals including Dr Hilary Cass and her review team.