I think Cass erred on the side of diplomacy when she said puberty blockers should only be assessed as part of a rigorous research trial because I highly suspect Cass knows damn well that such a trial would never get past any proper ethics committee because of the harm that would result, not to mention the very real problem as OldCrone points out of there being no clear indication as to what is being treated.
She knew if she said “not now, not ever” it would be a stick to beat her report with. Saying what she said doesn’t mean there’s a valid option of doing just that.
I had also come to the conclusion that this was probably the most likely reason for Cass acting as she has. The reactions on both sides have also been interesting as both sides seem to have reacted as if she had taken the much harder line.
Now all that remains to be seen is whether the NHS are actually capable of/will make any attempt to control the rogue clinicians who have been in the driving seat for so long. Those clinicians still hold too many cards. Persuading new and unbiased clinicians into this niche, toxic corner of medicine is going to be close to impossible. The waiting lists are presumably still huge.
While I admire the game I suspect Cass is indeed playing, I wonder whether, in time there will come to be regrets over not taking a harder line. If we eventually want to bring these doctors to justice, giving them any kind of wriggle room that allows them to justify continued experimentation on children might be seen, with hindsight, to have been a misstep.