NHS independent review into children's gender ID services

[carefulvulvadriver]

What do we know about Dr Hilary Cass? A cold hard look and analysis sounds a good thing, although I wouldnt have much faith in the CQC's inspection of the Tavistock

NHS Announces Independent Review Into Gender Identity Services For Children And Young People
22 September 2020
www.england.nhs.uk/2020/09/nhs-announces-independent-review-into-gender-identity-services-for-children-and-young-people/

The NHS has today announced that Dr Hilary Cass OBE, former President of the Royal College of Paediatrics and Child Health, will lead an independent review into gender identity services for children and young people.

The review will be wide-ranging in scope looking into several aspects of gender identity services, with a focus on how care can be improved for children and young people including key aspects of care such as how and when they are referred to specialist services, and clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria.

It will also set out workforce recommendations for specialist healthcare professionals and examine the recent rise in the number of children seeking treatment.

Dr Cass will then make clear recommendations for children and young people’s gender identity services reporting back next year.

The Gender Identity Development Service for Children and Adolescents is managed by the Tavistock and Portman NHS Foundation Trust.

The Care Quality Commission (CQC) is due to carry out a focused inspection of The Tavistock and Portman NHS Foundation Trust, Gender Identity Services for children and young people, during the autumn. The inspection will cover parts of the safe, effective, caring, responsive and well-led key questions and will include feedback from people using the service, parents, relatives, carers, and staff. Separately, Dr Cass will also review the service’s clinical practice with the support of the Royal College of Paediatrics and Child Health and engagement of other professional bodies to provide multi-professional insight working closely with the CQC.

The review includes an examination of the issues surrounding children and young people who are prescribed puberty blocking and cross sex hormone drugs.

Dr Hilary Cass OBE, independent chair, said: “It is absolutely right that children and young people, who may be dealing with a complexity of issues around their gender identity, get the best possible support and expertise throughout their care.”

“This will be an inclusive process in which everyone will have the opportunity to make their views known. In particular I am looking forward to hearing from young people and their families to understand their experiences.

“This review provides an opportunity to explore the most appropriate treatment and services required.”

A transparent and inclusive process for stakeholder engagement and consultation will be established to ensure that everyone who wants to can make their views known.

Dr. Michael Brady, the National Adviser for LGBT Health said: “Every child matters and children and young people who are exploring their gender or experiencing gender dysphoria, including those who are trans or non-binary, deserve the very best from the NHS.

“This is why this review is so important so that all health professionals can deliver the very best healthcare in a compassionate and understanding way.

“Throughout this process it’s critical we hear from children and young people, those who have accessed these services, their families and expert clinicians so I am pleased that Dr. Cass has put this at the heart of her approach.”

Professor Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges said: “This is a multi-professional issue and we are pleased that a formal review is taking place to provide a comprehensive, evidence-based view on this sensitive and complex subject.”

The terms of reference for the independent review have also been published.

The independent review will present recommendations to NHS England and Improvement’s Quality and Innovation Committee.

[YetAnotherSpartacus]

Oh, Ok, A systematic review. I get that...

[allmywhat]

Just a guess re the team from York but it seems to fit well:

www.york.ac.uk/crd/

[Manderleyagain]

That looks good. She is definitely saying that the treatments are currently experimental for this particular group of patients. She also emphasises the importance of being evidence based, and shows that she wants to know why the numbers have gone up so much, and why the demographic has changed to girls who experience gender issues later than the previous cohort of boys did.
It's taking a while though isn't it.

[Helleofabore]

I hear you. I hear you.

One can only hope that the evidence is clear and they cannot spin it any other way.

[YetAnotherSpartacus]

Yep got that. I wondered who they were. York seems pretty much captured...

[Helleofabore]

Sorry. Posted before ready.

She says it is a team from University of York of that is any help.

[Helleofabore]

I don’t know Spart. I was wondering too. But I am optimistic that maybe some good will come of it all.

cass.independent-review.uk/entry-5-evidence-epidemiology-october-2021/

[YetAnotherSpartacus]

Who is the team from York?

[Helleofabore]

Thanks thingybob. That is a positive start at least.

It is interesting to see organisations around the world start to admit that there is too little evidence around PB and CSH for adolescents and that there is significant issues that need to be identified and studied around the current cohort.

[Thingybob]

For anyone following this review there was an update posted to the website yesterday on Evidence and Epidemiology.

I think Hilary is saying in a roundabout way that hormone treatment is currently experimental so a team from York University has been appointed to fill some of the gaps in the evidence base.

There is also an acknowledgement that not all children with GD are one distinct group as "there will not be a one-size-fits-all approach to assessment, support and intervention"

[Tibtom]

But it is not impartial. Impartial is using scientifically and legally correct language. In addition 'assigning at birth' imposes on everyone so the 'audience' should be everyone.

[EmbarrassingAdmissions]

@Tibtom

Given the way language is manipulated by the ideology it is not good enough just to accept the way it is used. When children (and others) are told treatment enables them to change sex they believe it. When womanhood is reduced to gross sexist stereotypes it harms everyone.

Agreed.

I wonder if, as per her explanation, Cass is using the language as an expression of non-partiality, added to which is a non-acknowledged defence against future appeal points?

[Tibtom]

Given the way language is manipulated by the ideology it is not good enough just to accept the way it is used. When children (and others) are told treatment enables them to change sex they believe it. When womanhood is reduced to gross sexist stereotypes it harms everyone.

[Tibtom]

We use 'objects' instead of 'women' because that is the language our audience uses...

[Leafstamp]

This may explain the use of the phrase:

We use the phrase "sex assigned at birth" when we're talking about trans health and gender dysphoria, as this is the language our audience uses. In other cases, we use "the sex someone was registered with at birth" because user research shows that most people understand this better as it refers to an actual event.

From here: service-manual.nhs.uk/content/inclusive-language

In a way I find it encouraging that they recognise most people know that sex is observed and registered.

[Biscuitsanddoombar]

Sigh....the trouble is once you start using that language “assigned at birth” it’s impossible to row back from it.

[AnyOldPrion]

”Give your evidence,’ said the King; `and don’t be nervous, or I’ll have you executed on the spot. ‘ This did not seem to encourage the witness at all: he kept shifting from one foot to the other, looking uneasily at the Queen, and in his confusion he bit a large piece out of his teacup instead of the bread-and-butter“.

”Alice’s Adventures in Wonderland”

This is the part of that statement that challenges the suspicion that she’s going to go along with everything the trans lobby are demanding. If she was, she’d perhaps be less nervous, though maybe she is merely saying whichever way she jumps, there will be massive backlash.

She mentions the paucity of evidence and trying to work through that. At least she acknowledges the lack.

Perhaps the heavily gender medicine affirming language is because she recognizes that any step away from the demands will immediately result in accusations of transphobia and she is demonstrating that she has properly immersed herself in their culture. Still, the approach makes me less optimistic that the results will be genuinely independent and unbiased.

[jellyjellyinmybelly]

@TheFleegleHasLanded im interested in her using the phrase you highlight too. Perhaps she's thinking that assigned sex at birth doesn't make sense as sex is immutable so can't be assigned? Ie is this a hint of g c views?

Fwiw I've known of Dr cass for years professionally and she was a great head of the rcpch. Told things straight. In contrast I don't find Russell Viner much use (he is the most recent outgoing rcpch president and also uclh paeds endocrine Dr criticised by Bell judgement as one of lead authors of gids research that was so delayed and only published after bell.). Am crossing fingers a lot for something sensible!

[TheFleegleHasLanded]

Not a great start. My bold:

“ For many of the young people needing to access health services, the mismatch between their birth assigned gender and their gender identity can be intensely distressing; ”

cass.independent-review.uk/entry-2-how-im-approaching-the-review-march-2021/

[Thingybob]

The website is live

cass.independent-review.uk/

[Manderleyagain]

Just on the cass review's twitter account & blog - I think this is a really good sign. I'm quite impressed. She understands that there is a huge amount of interest in this, and that transparency and communication will be key. If she keeps the communication open and neutral like this it will go a long way to keeping things calm. It must be difficult stepping in to a heightened political context like this, and this is a good example of how to do it I feel. So far so good.

[highame]

committees.parliament.uk/work/947/the-role-of-the-geo-embedding-equalities-across-government/ That's why this consultation is important. It doesn't sound so at first but if you look closely it appears they are trying to get rid of Liz Truss. I think the Women & Equalities Committee is likely to be TWAW and I am responding saying I want to separate out women from equalities because women 50% of population and all the other groups are also affected by women's inequality. The equalities committee can then go and concentrate on equality for men in those groups because that's what they appear to want

[NecessaryScene1]

A cold hard look and analysis sounds a good thing, although I wouldnt have much faith in the CQC's inspection of the Tavistock

Interesting to note the comment in the OP, given that we've now seen the inspection report.

It seems like, once you get to a high enough level, and some independent review, the system is working in the UK. High-level courts are skewering what needs to be skewered, NHS reviews are identifying the problem, and the government is drawing back from self-ID and bringing in revised anti-Stonewall school guidance.

The problem is at lower "admin" levels, and lower-level courts. This is the general Woke pattern - getting activists into these middle positions where they get to do their activism thing (trans rights, "anti-racism", or whatever) as much as they can until someone notices.

There really does need to be some sort of meta review here - not just addressing the specific issue, but why/how these things got to this point without proper evidence/consultation. How is this stuff being driven? Why are people being activists rather than professionals?

Biggest disappointment though is the politicians. The percentage of politicians digging into this is tiny, and that worries me.

I guess I shouldn't be surprised. Politicians are not, generally, . Politicians dragged their feet on gay rights because it was an anti-gay public + chunk of establishment versus mostly-sane activists. Once the public wasn't anti-gay, the politicians flipped.

At the minute politicians are faced with insane activists, some establishment "yay equality" pressure, and a largely indifferent/unaware public. So they fold to the activists. But it's still a disappointment. If they can't see the issues here, are they up to the job?

There are more politician "activists" in places like that Crispin Blunt committee than general politicians asking difficult questions. I'm not seeing proper debate. Not good. Was not impressed by the unserious responses to Liz Truss's announcement.

[Thingybob]

Thankyou for the link NecessaryScene.

I'm not sure how these reviews normally work but surely this will a long drawn process (taking years rather than months?) if the review needs to first gather evidence through its own research programme.

[MaudTheInvincible]

Thank you NecessaryScene1 👍