Doctors feel “pressured to adopt an unquestioning approach” when treating children with gender dysphoria, an independent review has found.
The Cass Review is an independent report being led by Dr Hilary Cass OBE, a consultant paediatrician and former president of the Royal College of Paediatrics and Child Health.
It was commissioned by NHS England and NHS Improvement to make recommendations on the services provided to children and young people exploring their gender identity.
There is currently just one specialist service providing gender identity services for children and young people – the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust.
In recent years GIDS has experienced a significant increase in referrals which has contributed to long waiting lists and mounting concern about how the NHS should most appropriately assess, diagnose and care for these children and young people.
On Thursday, an interim report was published and found that while the staff working within the specialist service “demonstrate a high level of commitment” to their patients, “the waiting list pressure and lack of consensus development on the clinical approach” – combined with “criticism of the service” – have resulted in rapid turnover of staff as well as “inadequate capacity” to deal with increasing workloads.
It continued: “Our initial work has indicated that many professionals working at primary and secondary level feel that they have the transferable skills and the commitment to offer more robust support to this group of children and young people, but are nervous about doing so, partly because of the lack of formal clinical guidance, and partly due to the broader societal context.
It also concluded that: “Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.”
Large increase in referrals over past decade
According to the latest statistics published by GIDS, analysing the total number of referrals it received from across England, Wales, Republic of Ireland and elsewhere, there has been a large increase in the number of referrals over the past decade.
In 2010/11, there were 138 in total. However, by 2015/16 this rose to 1,409. In 2016/17 the number of referrals rose to 1,981. In 2018/19 the figure was 2,743.
It is anticipated that the pandemic has had an impact on the data over the last two years; for example, in 2019/20 the figure was 2,748 and in 2020/21 it was 2,383. The vast majority of those referrals were young people between the ages of 12 to 17.
The report said that as a result of this, children and young people are waiting lengthy periods to access GIDS, during which time some may be at “considerable risk”. By the time they are seen, their distress may have worsened, and their “mental health may have deteriorated”.
‘Lack of open discussion’
The report concluded that the “rapid increase” in the number of children requiring support and the complexity of their needs, means that the current clinical model, with a single national provider, “is not sustainable in the longer term”.
It also found that there is a “lack of consensus and open discussion” about the nature of gender dysphoria and “therefore about the appropriate clinical response” and that furthermore, because the specialist service has “evolved rapidly and organically in response to demand”, the clinical approach and overall service design “has not been subjected to some of the normal quality controls that are typically applied when new or innovative treatments are introduced”.
The Tavistock was contacted for comment.
