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Trans healthcare
Illustration Callum Abbott

The NHS is failing young trans people, rules new report

The interim report of the Cass Review found that long waiting lists at the Tavistock gender clinic are detrimental to the health of young trans people

On Thursday (March 10) the interim report of the Cass Review, commissioned by NHS England in 2020, was released. The report has recommended that a network of regional hubs should be created “as soon as feasibly possible” to provide gender-affirming care to trans children and young people and stressed that caring for young people with gender dysphoria is “everyone’s business”. 

At present, the only NHS gender identity service for children in England and Wales is the Gender Identity Development Service (GIDS) at the Tavistock gender clinic in London. Dr Hilary Cass, the retired paediatrician who is investigating the clinic, found that the treatment of young trans people at Tavistock was below normal quality controls. According to Dr Cass, “there is a lack of consensus and open discussion about the nature of gender dysphoria and therefore about the appropriate clinical response.” 

The report explained that an increase in referrals – from 138 in 2010-11 to 2,383 in 2020-21 – has resulted in overwhelmed staff and lengthy waiting lists for young trans people trying to access care. Dr Cass argued that regional hubs would have many benefits, such as reducing waiting times for specialist care.

Access to care is vital when it comes to improving the mental health of trans youth: a recent study found that gender-affirming care for young trans people, such as hormone therapy and puberty blockers, was associated with 60 per cent lower odds of moderate or severe depression and 73 per cent lower odds of suicidality.

Although the report rightly draws attention to how trans children and adolescents are being failed, many people have voiced their concerns about transphobia in the report – namely the pathologisation of transness. Advocate and parent of a trans child, @FierceMum, wrote on Twitter: “I feel deeply uncomfortable with any trans allies or trans supportive orgs in any way getting behind this report. Yes there are some things in there that everyone can agree on, that the current system is broken. But the pathologisation throughout makes me deeply concerned.” Their partner and fellow advocate, @DadTrans, shared similar sentiments: “This is a deeply flawed, systemically transphobic report into the UK's crisis in adolescent trans healthcare,” he wrote.

Others were more optimistic. @LGBwiththeT tweeted: “Although the interim report has some dog whistles thrown in for good measure, there are seeds planted of improving the gender service for children, which has been awful and letting children down now for far too long. Fingers crossed the final report doesnt ruin this.”

A spokesperson for the Tavistock and Portman NHS Foundation Trust said they welcomed “the focus on increasing and broadening the care and support available for this group of patients who are currently waiting far too long and on developing the evidence base”. One thing is abundantly clear: the system is broken and trans youth across the country urgently need access to gender-affirming healthcare. Only time will tell what Dr Cass’ final report – due at a later date – will do to address this.