Read again: Gender identity services: Recommendations for NHS England

Dr Hilary Cass, in her capacity as Chair of the Independent Review of gender identity services for children and young people, has presented her final report and recommendations to NHS England. This review, commissioned to enhance NHS gender identity services, seeks to ensure safe, effective, and holistic care for individuals questioning their gender identity or experiencing gender dysphoria. Understanding these recommendations can help practice managers navigate the complexities of gender identity services, fostering a safe and welcoming space for children, young people, and their families

CREDIT: This is an edited version of an article that originally appeared on The Cass Review

In recent years, there has been a noticeable surge in referrals of children and young people seeking support around their gender identity. This upsurge has led to prolonged waiting times for clinical support, leaving individuals and their families to navigate challenges independently. Dr Cass’s review delves into the underlying factors contributing to this trend and aims to identify optimal clinical approaches and service models to address these issues.

Key findings overview

The review’s findings shed light on various critical aspects:

• The increase in referrals arises from a complex interplay of biological, psychological, and social factors, with no single explanation.
• Conflicting views on clinical approaches have led to challenges in delivering consistent care, often diverging from usual clinical practice.
• Existing international guidelines lack applicability to NHS England, necessitating a tailored approach.
• The evidence base for gender identity care is characterised by poor quality studies and misrepresentation, hindering informed decision-making.
• Controversies surrounding medical treatments have overshadowed the core goals of care, necessitating a re-evaluation of priorities.
• Uncertainties persist regarding the long-term impacts of puberty blockers and hormone treatments, highlighting the need for further research.
• Identifying individuals with enduring trans identities remains challenging for clinicians, underscoring the complexity of gender identity.

Recommendations overview

The recommendations put forth by Dr Cass advocate for a holistic approach to healthcare, aligning with standard NHS clinical practice. Key recommendations include:

• Standardising service quality to match other healthcare sectors, ensuring consistency and reliability.
• Expanding service capacity through a distributed model with stronger links between primary, secondary, and specialist services.
• Conducting comprehensive assessments for individualised care plans, taking into account a range of factors.
• Providing evidence-based psychological and psychopharmacological treatments to address gender-related distress effectively.
• Establishing separate pathways for pre-pubertal children and detransitioning individuals, recognising the unique needs of these groups.
• Implementing a comprehensive research program to enhance understanding and outcomes in gender identity care.

Dr Cass’s recommendations offer a roadmap towards more effective and inclusive gender identity services within NHS England. By prioritising holistic care, evidence-based practices, and ongoing research, the NHS can better support children, young people, and their families on their gender identity journeys. It is imperative for NHS England to consider and implement these recommendations to ensure that individuals questioning their gender identity receive the support and care they need.