Cass report recommendations examined by Scotland clinical team

Puberty blockers should continue to be paused and work on a regional service for children should begin immediately.

That’s according to senior clinicians tasked with considering how recommendations from the Cass Review might apply to the NHS in Scotland.

The review, which was published by Dr Hilary Cass earlier this year, made a series of recommendations about what should change in the provision of transgender healthcare for under-18s.

It led to the NHS in Scotland pausing the prescription of puberty blockers and hormone treatments to new patients under-18 after Cass claimed there was “remarkably weak” evidence on medical interventions.

Led by Chief Medical Officer Professor Gregor Smith, a team of clinicians in Scotland has now submitted their findings on the Cass Review to the Scottish Parliament.

Of the 32 recommendations the team found the majority are either applicable or partly applicable.

Their recommendations state that a lead senior clinician should take overall responsibility for each young person’s care and that each care plan should include a full assessment of the child’s needs, both psychological and physical.

They also advise that the use of puberty-supressing hormones – commonly referred to as puberty blockers – should be paused until further clinical trials can be undertaken.

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

The team sought views from relevant experts, including psychologists, psychiatrists and paediatricians, aswell as Dr Hilary Cass.

Pre-election rules prevented publication in the run-up to the UK General Election, but a commitment was made to parliament to publish at the first opportunity after the restricted period ended.

The conclusions of the report will now be considered by the Scottish Government – both in relation to how current services should be delivered to ensure service continuity, as well as on how these services should be commissioned in the future to ensure sustainable person-centred care

The Cass Report, published on April 10, looked at gender identity services for under-18s in NHS England.

It found gender medicine to be operating on “shaky foundations” when it came to the evidence for medical treatment like prescribing hormones to pause puberty or to transition to the opposite sex.

Deputy Chief Medical Officer Professor Graham Ellis said: “The Cass Review was established to make recommendations on how to improve NHS England gender identity services for children and young people. Through this review we have aimed to set out which recommendations could apply to Scotland, and how they might be implemented.

“At the heart of this question are children and young people in distress, and our ambition must remain focused on meeting their needs with holistic, person-centred care as close to home as practical.

“The Cass Review identified the need to ensure that gender identity services for young people are more closely aligned with other areas of clinical practice, and that responsibility for the full range of services required should extend beyond specialist services. This will be essential as we seek to always provide the best possible care.

“In responding to the Cass Review, the multi-disciplinary team looked at the recommendations from a clinical perspective, always remembering that we have a responsibility to make sure that all children and young people grow up safe, respected and supported.”

The Scottish Government welcomed the report and confirmed they will update Parliament after the summer recess.

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.

“The Scottish Government will update Parliament after summer recess.

“We remain absolutely committed not just to ensuring ongoing support is available, but to reforming and improving gender identity healthcare across Scotland.”