The Bigger Scandal Of The Cass Review

Many Gender Clinics In The NHS Refused To Take Part In It

Dr. Hilary Cass

So, the Cass Review has been released, much is going to be said about it in the coming days and while I haven’t read the whole thing in detail to make any assessment on the contents (though I am somewhat disturbed by the language Cass used in the report that seems to allude to a “gender essence” from what I have seen so far - and I may be wrong about that) there was something in the report on Appendix 12 that got my attention: a letter written by Dr. Cass to John Stewart, National Director, Specialized Commissioning NHS England and NHS Improvement.

(emphasis mine)

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Dear John

INDEPENDENT REVIEW OF GENDER IDENTITY SERVICES FOR CHILDREN AND YOUNG PEOPLE – QUANTITATIVE RESEARCH PROGRAMME

I am writing in response to your letter of 17 January regarding the Review’s commissioned quantitative research programme, advising that, despite your welcomed efforts to obtain cooperation, most of the NHS gender clinics have refused to take part in this research. 

It has not been at all straightforward trying to get this research off the ground. It has absorbed a considerable amount of time and attention from the Review and the researchers at the University of York, as well as from NHS England and the Department of Health and Social Care, all of which has delayed our work.

The study follows usual NHS research practice, it is only novel because of the sensitivity of the subject matter and the issue of changing NHS Numbers, which was overcome by the Statutory Instrument (basically had to have the law changed - Ed.). It is therefore hugely disappointing that the NHS gender services have decided not to participate with this research. I am frustrated on behalf of the young people and their families that the opportunity to reduce some of the uncertainties around care options has not been taken.

Ultimately, the NHS is an evidence-based service with a responsibility to maintain the safety of those in its care. Understanding more about what support people who attended the Gender Identity Development Service (GIDS) received, and whether this helped them, will provide vital evidence to assist young people, their families, and the clinicians working with them to make informed decisions about the right pathway for them. As a single integrated health service, which for the period in question had one provider of care for children and young people, this was a world leading opportunity to look at outcomes for c.9000 young adults and add to the evidence base.  

We had hoped to have some early findings to inform the Review. However, as outlined in my letter to you of 31 January 2023, it had become evident that the full outputs from the study, including resulting peer-reviewed papers, would not be available in time to be published alongside my final report.

I asked that NHS England give consideration as to how the ambitions of this study could be realised beyond the life of the Review. I am grateful for your confirmation that the National Research Oversight Board will support this going forward.

To assist the Oversight Board, I attach detail on the circumstances that led the University of York to reach the conclusion that it was not yet possible to move ahead with the next stages of the research study (Annex A).

I look forward to submitting my final report and recommendations in the coming weeks.

In the meantime, my recommendations on this specific issue are that NHS England:

1. Work with the University of York to take forward phase one of the data linkage study without delay.

2. Work with Department of Health and Social Care to mandate the data exchange from the clinics to facilitate this.

3. Undertake a case note audit of record keeping in the adult clinics to assess the feasibility of phase 2 of the data linkage study.

Yours sincerely

Dr Hilary Cass

Chair, Independent Review into Gender Identity Services for Children and Young People.

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What’s astonishing is that any of the gender clinics who refused to take part in the study was legal.

There is no reason why a service that says it offers evidence-based care to obstruct Dr. Cass from gathering data that would provide that evidence, unless they know this would uncover something they are desperate to keep out of the public domain.

An over-charitable person can imagine a situation where overwhelmed doctors buy into bad research, think they’re doing the right thing, etc.

But this is blatant obstruction of a government inquiry commissioned to help kids!