A long-awaited overview of how the NHS should care for children and adolescents with gender dysphoria will be published on Wednesday.
The findings of the research by leading pediatrician Dame Hilary Cass will shape NHS England’s new services for children and young people who are questioning their gender identity or experiencing gender incongruity.
The review is expected to confirm a fundamental shift in the treatment offered to children and adolescents who question gender, moving away from a medicalized approach and towards a more holistic treatment pathway that considers gender issues in context with other potential issues in childhood. will consider. to live.
The publication comes after three and a half years of work. Cass’s interim recommendations have already had a significant impact on the evolution of this part of healthcare.
Its interim report, published in February 2022, led to the closure of the specialist gender identity development service (Guide) for children and adolescents, which was previously managed by a single provider: the Tavistock and Portman NHS foundation trust in London.
Cass said the single specialist service provider model was “not a safe or viable long-term option” and that a “fundamentally different service model” was needed. Services were difficult to access: young people waited more than two years for a first appointment; Cass was also critical of the lack of data collection on what happened to children and young people who were prescribed hormones.
Her preliminary findings also led to a decision last month by NHS England to stop prescribing puberty blockers to children, based on a review of available evidence on their safety carried out by the National Institute for Health and Care Excellence.
NHS England said there is “not enough evidence to support the safety or clinical effectiveness of puberty suppressor hormones to make the treatment routinely available at this time”.
Last June, Cass published intermediate guidance on how NHS England should deal with children with gender dysphoria, announcing a multidisciplinary model to ensure the focus on gender does not obscure other issues in a child’s life. This new approach recommended that in addition to considering gender identity when meeting patients, doctors should also consider adverse experiences, sexual orientation, mental health and wellbeing at school.
Cass, former president of the Royal College of Paediatrics and Child Health, was commissioned in September 2020 to carry out an independent, wide-ranging expert review into Guide, to make recommendations on how the NHS can improve its services for children and young people with issues with their gender identity to “ensure that the best models for safe and effective services are put into use”.
The review came in response to a significant increase in referrals to the Guide, run by Tavistock and Portman in London and Leeds. In 2011-2012 there were just under 250 referrals to the service; in 2021-2022 this had increased to over 5,000 referrals.
The increase occurred at a time when the service had transitioned from a talk therapy model to one that also prescribed medical interventions in the form of hormone medications. The research also aimed to understand why there was a disproportionate increase in the number of girls with gender dysphoria being referred for specialist attention.
New interim services, led by London’s Great Ormond Street Hospital, were rolled out by NHS England from this month. The original goal was for the clinics to open in spring 2023, but this was postponed due to difficulties in hiring and training staff for the services. About 5,000 children and young people are on the waiting list for referral to the new clinics.