Cass Review (UK, 2024)
The Cass Review is the independent inquiry into gender care for children and young people within England’s National Health Service (NHS). NHS England commissioned the inquiry in 2020, under the leadership of Hilary Cass. The final report was published on 10 April 2024.
What it says
The report draws, among other things, on literature reviews by the University of York. In her foreword, Cass writes that this is an area of 'remarkably weak evidence' and that there is no good evidence on the long-term outcomes of interventions to manage gender-related distress (source). On puberty blockers, the report states (para. 14.25) that the data suggest they do not buy time to think, because the vast majority of those who start them go on to masculinising or feminising hormones. The report recommends a trial of puberty blockers as part of a broader research programme, a comprehensive assessment of young people that covers, among other things, mental health and neurodevelopmental conditions such as autism, and organising care in a network of regional centres.
Consequences
NHS England wrote to Cass that it is fundamentally changing care for young people: the Tavistock clinic GIDS closed on 31 March 2024 and the first two regional services opened on 1 April 2024 (source). In the Netherlands, the House of Representatives asked the government to respond; its response came in a parliamentary letter dated 4 June 2024. An analysis of how the report was covered in the Dutch press can be found on gendermedia.nl in the Cass Review in the Dutch media. An extensive discussion is available on the page about the Cass Review. The report also addresses the differences from the Dutch Protocol.
How the inquiry was conducted
NHS England commissioned the inquiry in autumn 2020. An interim report followed in 2022. According to the final report, it became clear early in the inquiry that a single national service, the Tavistock clinic GIDS, was not a safe or viable long-term option. For the final report, Cass commissioned eight systematic literature reviews from the Centre for Reviews and Dissemination at the University of York (two of them on guidelines). They cover the characteristics of referred young people, social transition, psychosocial interventions, puberty blockers, hormones, care pathways and clinical guidelines, and were published on 9 April 2024 in the journal Archives of Disease in Childhood. The final report contains 32 recommendations. On social transition, the report advises a more cautious approach for children than for adolescents, with clinical involvement of parents, because social transition in childhood may change the trajectory of identity development. A planned data-linkage study of approximately 9,000 young people referred to GIDS was halted on 30 November 2023 because six of the seven adult clinics would not cooperate (source). More information about this type of research can be found under systematic reviews in gender care.
Reception and criticism
The Royal College of Psychiatrists welcomed the final report (source). The British Psychological Society praised Cass’s work and supported the expansion of capacity (source). The Royal College of Paediatrics and Child Health stated on 10 April 2024 that it would first review the recommendations in full (source). By contrast, a group of researchers around Meredithe McNamara of Yale School of Medicine published a critique accusing the report of methodological shortcomings in 2024 (source). In July 2024, the council of the British Medical Association adopted a motion criticising the report and its implementation, and on 8 August 2024 the BMA announced its own evaluation (source). In March 2024, NHS England decided to make puberty blockers no longer routinely available and to allow their use only within research (source). An earlier British literature review is included in this archive under NICE Review (UK, 2020).