Hilary Cass' Latest Blog

[Appletreefarmyard]

I can't see any commentary on this board about Hilary Cass' latest blog:
cass.independent-review.uk/entry-8-beyond-the-headlines/

The CEO at the Tavi seems to think this vindicates GIDS and confirms that their work has been, and will continue to be, highly valued.

As far as I can see, there is still no acknowledgment that they have been at fault in any way.

I don't even think that this is a position being adopted for the purposes of future law suits. I think they genuinely believe it!

I read this the other day and thought that she said nothing that wasn’t what we had already worked out.

I think there is a lot of saving face happening. But ultimately, they, the Tavi, are publicly maintaining that it is waiting lists, and glossing over the holistic and multi disciplined approach.

I suppose from my very GC point of view, the biggest frustration with the Cass Review is that it is just not damming enough. It does seem to be very mild in its criticism of the service to date, and the whole ideology, that leaves it open to interpretation by different parties.

However, there is not a lot of ambiguity here :

in my interim report I said that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand. The purpose of the regionalised model is to improve access, networked care, research capacity and workforce development

Not safe or viable, how can that be positively spun?

this will mean improved access to services with flexible pathways that better respond to their individual needs.

Surely the implication of this is that the service did not previously have flexible pathways, when it should have?

i am pleased that NHS England has taken on board the Review’s advice to date and has set out the interim arrangements being put in place to move towards the new delivery model

So put this together - the service was not safe or viable, more options need to be available, the delivery model will not be the same as before.

Is hillary Cass just being very careful about explicitly criticising anyone? Should she actually be more specific about what harms have been done and by whom? Is that within the scope of her review?

Do others find it frustrating this seems to be missing?

And therefore carmichael, Stonewall, Mermaids et al can keep spinning their line that it is just waiting times being addressed.

Wouldn't it be useful, helpful, possible for Cass to actually state, no, this is not just about waiting times, stop saying it is, so there is no room for ambiguity!?

I reckon she's modelling diplomacy. Given the wholesale capture of so many medics by trans extremist views she's holding the line when she says:
"The purpose of my Review is to be forward-looking and define what a safe system of care should look like, and how to support that care with the best evidence". She's already spelled out the problem with the lack of evidence, data and research leading to an unsafe care for children. She's clearly but respectfully leading the way and not getting caught up in the normal "ah buttery" that we see so much of with this ideology. .
They can deny, obfuscate and wail - but she's clear that the safety of children is what matters.

From what I've read of Cass' work she seems to be cautious, clear and working on the basis of looking for evidence. Thats exactly as it should be.

There is no room for anyone to question her integrity or method- she is going to recommend enormous changes and needs to stick to this methodical, thorough and non-sensational path.

I've been really impressed by her work so far, and I'm fairly sure that if that approach is applied to the issue there will be massive shifts within the sector.

I read it as "we need some kind of program to address this medical need(localised is better). The meat factory we have now doesn't work".

I was pleased to see Cass say in relation to schools, social services and mental health that professionals recognise that it is not helpful to exceptionalise gender identity issues, and that they have the transferrable skills to work in this area. She's right - and that's a very powerful reminder to all the professionals who have allowed themselves to be deskilled by the gender woowoo crowd. The fact that they allowed this to happen does need investigating, given the awful impact this has had on so many vulnerable children.

Reinforcing that schools should not be signing up to allow political activist groups like Stonewall, Gendered Intelligence, Global Butterflies and the rest to undermine safeguarding, pastoral care and a facts based curriculum would also be a help.

I agree Arabella.

I think Cass is doing a great job. I think she is taking a neutral position regarding ideology. I think her sensitivity is coming from a position of compassion - she is spending a lot of time with Tavi patients and will no doubt see their struggles and vulnerability.

The Tavi are adopting a position that the 'unsafe' and 'not viable' references are linked to long waiting lists and capacity issues. There is some element of truth here. I am beyond frustrated that they aren't looking to learn from what Cass makes clear (to many) were shortcomings. I think this issue is what got them into the mess. Right back from when David Bell started raising issues.

Whilst it is obvious to many that this is an overly defensive stance, they are maintaining there is nothing to defend or correct.

Presumably Appletree denial is a necessity for the GIDS senior staff given the tsunami of lawsuits heading their way. Cass is uncompromising about the unsafe care and detailed what that looks like - spinning it to mean just waiting lists seems to be an exercise in self preservation?

If a child is in distress they need to be seen; the long waiting list is very bad news and creates a gap for unqualified and perhaps money-motivated people to step in.

Children with 'gender variance' should be seen quickly and offered a high standard of evidence based care.

For most this would be accessing support - whether that's mental health support or autism assessment or addressing comorbidities. For some it might be being told they are going through the normal processes of adolescence, and for some very few it may mean support with a possible trans identity.

Bolstering CAMHS etc can only be a good thing, and yes I think Cass opening this up and saying it's everyone's business is a great way of letting sunlight and good sense into the issue.

Demystify it. Do the research, find the evidence, ask the questions.

I think if she can bring an acceptance of the fact that "trans" isn't a health issue we're on a good track.

Gender dysphoria clearly is. But it could be a symptom or result of other co-morbidities. it could be part of processing puberty while having autism. It could be a result of abuse. It could simply be peer pressure.

Expecting complete mental health support rather than immediate medication and a fast track to surgery is definitely positive and I think Cass is going about this well.

I agree.

personally I think it’s best that Cass avoid anything that reeks of ideology and that includes arguing against it.

the issue needs to be approached as other reviews within the NHS are approached, neutrally and without a preconceived outcome (although obvs if no concerns existed no review would be taking place).

that Cass has never used the phrase ‘transgender children’ is a very good thing, to my mind.

and the GIDS defence re: wait times and understaffing is completely undermined by the fact that GIDS is being closed down. If it was a capacity issue then new regional services could open and GIDS could just become the regional service for the SE.

That GIDS is being completely closed down and the paediatric gender patients will be transferred to a proper big children’s teaching hospital known globally for it’s research and expertise in numerous rare conditions rather than remaining in Tavi and Port (an odd little institution quite different to the majority of the NHS)

even the endocrinologists who have been providing the blockers/hormones for GIDS are being cut out of the loop as the Northern service is going to be RMCH&Alder Hey (and not Leeds) and the Southern service is going to be GOSH (and not UCH)

I suppose the proof of the pudding will be in how many of the current London and Leeds GIDS staff apply (and get!) jobs in the new services?

I wonder if any of the thoughtful ex GIDS employees (who quit in protest at the lack of professional rigour) will be interested in the new services (eg these authors: journals.sagepub.com/doi/10.1177/1359104518825288?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed )

Oh, that’s interesting- just noticed that an ex GIDS psychotherapist (one of the ones who raised concerns and eventually quit) is now doing a PhD on early gender non conformity and it’s relationship eating disorders (which to me sounds like a PC sideways-in way to properly examine some of the issues that have come up at GIDS - if so, well done to him!)

www.researchgate.net/profile/Anastassis-Spiliadis