THE publication of the much-anticipated Cass Review into gender identity services for children and young people in England has predictably been met with controversy.

While gender-critical campaigners hail the final report as vindication for their concerns about medical interventions such as puberty blockers, others fear it will result in yet further barriers to young people receiving appropriate healthcare.

However, before examining the potential political fallout in Scotland, it’s worth looking at what the report actually recommends.

More care, less toxicity

DR Hilary Cass, who was tasked with undertaking the independent review, made a series of recommendations about what needs to change in gender identity healthcare for young people in England.

She called for more regional providers of gender identity healthcare to be established “as soon as possible” in order to slash waiting lists and provide a better standard of care.

Last year, NHS England announced that it would be closing the Tavistock clinic, which at the time was the sole provider of NHS gender identity care for young people in England.

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The clinic was shuttered last month and replaced with a southern hub in London and a northern hub in Liverpool.

However, Cass said that the “highly emotive and politicised” context of the hubs’ creation had impacted their ability to recruit the right staff.

She added: “A distributed model of care is needed to meet current demand and provide a more appropriate holistic, localised and timely approach to caring for children and young people needing support.”

She also noted the “exceptional toxicity” of debate around trans healthcare for young people, adding that it failed to serve those seeking treatment.

The National: Dr Hilary Cass published her review into gender identity care for young people in England earlier this weekDr Hilary Cass published her review into gender identity care for young people in England earlier this week

“Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse,” she said.

“And in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.”

Indeed, Cass recommended more peer-reviewed research on trans healthcare and even encouraged children and young people currently in the system to take part in long-term studies on the use of medical interventions.

Individualising care was also highlighted as essential, including screening for autism and assessing a patient’s mental health to inform their care plan.

The Sandyford clinic

HOWEVER, less than 24 hours after the report’s publication, senior psychiatrist David Bell had already led calls for the Sandyford clinic in Glasgow – the only place in Scotland currently providing public gender identity services for under-18s – to shut.

While SNP MP Joanna Cherry and former Scottish Greens leader Robin Harper wrote to chief medical officer Gregor Smith urging him to “urgently consider the findings of the Cass Review and commit to implementing its recommendations in Scotland”.

Cherry and Harper note Cass’s criticism of the World Professional Association of Transgender Healthcare (WPATH), whose guidelines she said relied upon “poor quality” research.

They added that NHS Scotland’s relationship to WPATH guidelines “must be urgently reviewed” in light of the Cass Review.

However, two transgender Scottish academics have warned that the “politicisation” of the report’s findings cannot be allowed to guide decision-making in Scotland.

“There’s nothing in the report about Scottish services,” said Dr Ruth Pearce, a lecturer in community development at the University of Glasgow who has previously researched patients’ experiences of transgender healthcare in the UK.

“It’s a report commissioned by NHS England and applies specifically to English services, which are run very differently from those in Scotland.”

Pearce added that criticism of the report also had to be taken into account - namely, the decision to exclude those with lived or professional experience with transgender healthcare in England from contributing.

Indeed, one experienced psychiatrist at a gender identity clinic in England – who did not wish to be identified - told the Sunday National that failure to do so had concerned many within the field.

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They said: “The terms of reference stated that the Cass Review ‘deliberately does not contain subject matter, experts or people with lived experience of gender services’ and Dr Cass herself was explicitly selected as a senior clinician ‘with no prior involvement … in this area’.

“Essentially, ignorance of gender dysphoria medicine was framed as a virtue.

“I can think of no comparable medical review of a process where those with experience or expertise of that process were summarily dismissed”.

Dr Gina Gwenffrewi, a researcher with a PhD in transgender studies at the University of Edinburgh, added that implementing the findings of a report that some trans people viewed as illegitimate would also create difficulties.

The National: The Sandyford sexual health clinic in Glasgow The Sandyford sexual health clinic in Glasgow (Image: NQ)

“A review about trans people with minimal input from trans people themselves is going to lose a degree of legitimacy,” she said.

“Combine that with calls to shut down the only NHS gender clinic providing care to young people in Scotland and it’s no wonder people feel it’s being politicised.

“Closing Sandyford for young people would only exacerbate problems identified in the Cass Review, such as long waiting lists and a lack of research.

“Making something worse is not a solution”.

A review of transgender care in Scotland

THE Scottish Government has said it will “take the time to consider the findings of the final report in the context of how such healthcare can be best delivered here in Scotland”.

However, Pearce added that those seeking full implementation of its recommendations were likely to be disappointed.

“I don’t think we can expect the report to be implemented in full in Scotland,” she said.

“Cass herself has already said that some of her recommendations may be ignored or implemented differently in England – and that’s regardless of whether those recommendations are supportive of one side of the debate or another.

“I expect a similar thing to happen in Scotland.

“We have a different NHS, different gender identity services, so assuming that a study conducted in England automatically applies to Scotland seems a bit Anglo-focused.”

Gender identity services for both adults and children are already being reviewed by NHS Scotland, with results for adult care expected to be published before summer.