Children and young people’s gender services: implementing the Cass Review recommendations

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NHS England has just published its response to the Cass Review:

www.england.nhs.uk/publication/children-and-young-peoples-gender-services-implementing-the-cass-review-recommendations/

I've not read the full report yet but it doesn't seem to have been influenced by the BMA response last week!

It's a good roadmap of NHS England's plans to implement the Cass Review.

The vision of the Review – reflected in the NHS England implementation plan – is to increase available services for gender-questioning young people.
Those services will take a holistic approach to care which addresses the needs of each individual and will put in place a full package of care which can be delivered as close to home as possible.
We don’t know enough about who might benefit from medical interventions as part of their package of care, but if the clinical team think that this may be the right pathway for an individual, they will have access to those treatments as part of a carefully constructed research programme; this approach will give a better evidence base for future generations of young people.
In order to make things better in the future, NHSE needs the support and engagement of all the young people and families using these services, so I do hope that despite the frustrations and challenges that everyone has faced, there will be a real collaboration in developing the model of care together.
This implementation plan from NHS England is an important milestone in improving care, but the NHS now needs to focus on delivering additional capacity and an improved service offer to this group of patients.

I see that recruitment for the PSH trial starts in Feb. 2025.

• Professor Emily Simonoff has been confirmed as Chief Investigator for the study.
• The research will be co- sponsored by King’s College London and the South London and Maudsley NHS Foundation Trust. The study protocol should be complete by December 2024 and, subject to academic approval, recruitment to the trial would commence in early 2025.

https://www.dailymail.co.uk/health/article-13718465/nhs-gender-clinics-children-tavistock.html#

I know it's the Mail but are they really opening 6 more clinics?

This was reported on the BBC and when I saw the headline I rolled my eyes.

NHS sets out 'safer' care plan for child gender services - BBC News

But having read the article it might not be all bad.

It says "The emphasis will be on providing a more holistic approach, with a particular focus on supporting mental health and those with conditions such as autism."

And it ends with mention of the BMA's recent petulance, saying "The BMA statement was in contrast to much of the medical establishment which has been supportive of the changes."

Tide turning? We can but hope....

Not wishing to derail but to add to the discussion - Transgender Trend has written an excellent piece about how Cass effectively challenges the uninformed and downright dangerous "gender affirming" approach that so many unqualified adults in schools have inflicted on not only gaslit and confused individual children, but also on whole school communities who have been forced to comply with this dangerous for children ideology:

https://www.transgendertrend.com/gender-affirming-model-schools-what-does-cass-tell-us/

Well worth sending to parents and all adults who work in schools

Article in the Telegraph.

https://archive.ph/S2gUW Cross the paywall, come back, go again...

https://www.telegraph.co.uk/news/2024/08/07/trans-first-service-detransition-cass-review-birth-gender/

A service for detransitioners amongst other stuff.

More clinics and an actual puberty blocker trial?

Really? How would any trial be ethical?

Unusually, but suspiciously in my view, the BBC just had this on as a main feature on the 6 PM news. They presented it as "welcome" and said that the BMA "had concerns" about the ban on puberty blockers. The public will not be aware that the BMA, in this instance, is a small group of activists not your average doctor.

Personally feel after so much non coverage by the BBC of significant events and findings, that they are now riding the wave provided by the coverage of the males with DSDs in women's sports.....and trying to somehow link the two.

Open letter from doctors and medical leaders to the BMA:
https://www.thetimes.com/article/790de255-e511-4cd0-b549-4519a0d6ff2d?shareToken

I’ll be very surprised if this doesn’t hit the buffers at the ethics committee stage. The process has to be seen to be done, though.

I came on to see if that had been posted yet.
The BMA seems not to be really a medical organisation, more a politicised union - but one which doesn't consult with or represent the views of its members on important issues so it's not exactly functioning as a union either.

The BMA has never been a medical organization.

It thinks it is both a union and a professional body.

But it's actually a bit of a crap union. And there are various colleges for all the different medical specialities who are the actual professional bodies - they are also varying levels of competent (for example overseeing the physician associate debacle) but that is what they are there for.

The role of the BMA is generally misunderstood by the public as seen when angry patients will say 'I'm going to report you to the BMA!' It is a doctors union with delusions of grandeur.

More clinics is a great thing, so long as they are providing holistic care. There is a massive shortage of mental health provision and young people who think their distress is due to gender need help with their distress. There is every chance their gender issues are a symptom of treatable conditions so providing this is available, that's great.

The protocol for the research on PBs is being developed. This will then need to receive ethical approval from KCL and NRES. Both have robust criteria that are applied equally to all research proposals and centre on protecting participants. If they deem the design ethical, then fair enough.

I

"The role of the BMA is generally misunderstood by the public as seen when angry patients will say 'I'm going to report you to the BMA!' It is a doctors union with delusions of grandeur."

I think people sometimes refer to the BMA when they are thinking of the GMC.

They can't have more clinics providing holistic care whilst criminalising holistic care under the guise of 'conversion therapy'.

There is no protocol for 'which kids do we sterilise for being gay/lesbian/autistic/the child of a registered sex offender/liking the wrong toys?".
We already know they will try every trick in the book to push any boundaries to give kids these drugs.

The protocol for the research on PBs is being developed. This will then need to receive ethical approval from KCL and NRES. Both have robust criteria that are applied equally to all research proposals and centre on protecting participants. If they deem the design ethical, then fair enough.

The protocol is to be published in December. It's a fast turnaround from that to starting recruitment in Feb. 2025. Although a fair amount seems to have been the subject of scrutiny already with NHS E and NIHR.

Some thoughts from Andy Lewis.

https://www.quackometer.net/blog/2024/07/what-would-an-ethical-clinical-trial-into-puberty-blockers-look-like.html

Somewhere (I can't find it) I saw a suggestion that this trial will substantially recruit boys. I can't recall why but I remember thinking the reasoning was plausible at the time.

More clinics could potentially be a good thing, particularly if they were dealing with all of the various mental health issues these children suffer from. I think the challenge will be ensuring that these are not staffed by the same ideological experts who have been pushing trans medicine all of these years. They are likely to be first to apply and they do have a track record - an appalling track record but a track record nonetheless. Definitely a challenge for appointment committees.

Yes, people muddle it up with the GMC which regulates doctors. As far as I can see doctors are not obliged to join the BMA, although I can’t see if there is an alternative union to join other than the HSCA, which is for postgrad hospital doctors.

am hoping that if my DS makes it to med school and out the other side that he can avoid this union like the plague. Although, maybe in 6-8 years, this nightmare cult will have self imploded and he will be able to practice without all this BS.

Another article in the Telegraph

https://archive.ph/weec8 paywall bypass

https://www.telegraph.co.uk/news/2024/08/07/trans-extremism-is-still-rife-in-the-health-service/

I do worry that having spent years waiting for treatment, these children and their families will have been marinating in trans orthodoxy on-line. They'll be utterly sold on the idea that this is their panacea and they'll meet NHS unwilling (because tra) or unable (hello conversion therapy!) to challenge that.

...and one final Telegraph article that, I think, is of tangential interest. It's about a different but similar disorder.

https://archive.ph/jU6RD bypass paywall

https://www.telegraph.co.uk/news/2024/08/07/ten-minutes-of-tiktok-content-promoting-anorexia-harmful/

The parallels are obvious but it's transphobic to see them.

There is no protocol for 'which kids do we sterilise for being gay/lesbian/autistic/the child of a registered sex offender/liking the wrong toys?"

In our (family and friends) experience it's 'being a teenager with a seriously ill family member'.

Admittedly three is not a statistically significant number, but I'd be interested to know if it's more widely correlated.

On the BMA: full admission, but I have to say, never having thought about it much, I reckon I assumed the BMA was some kind of supervisory body, say roughly equivalent to the Bar Association (Bar Council now). I suspect I'm not the only one who was under that impression.

This is the danger, it is all the vulnerable kids getting sterilised, not the non binary celeb kids who just want attention.

@SpanielintheWorks a long time ago I worked with teenagers with cancer.

It was a very common pattern for one child to have cancer and a sibling to be anorexic.

I certainly have seen trans children with a terminally ill parent and it was screamingly obvious to all involved that they would not be trans with a healthy parent.

I wish the NHS was rolling out extra clinics and support of teenagers with all kinds of mental health needs, not just the ones expressing distress in terms of gender.

I think that the prospect of a readily understandable treatment pathway, and the simplicity of the explanatory model for distress, are big factors in the hold this set of ideas has gained amongst kids.

They don’t need gender clinics, they need youth mental health clinics.

Absolutely.