Cass Review (UK, 2024)
The Cass Review is the independent inquiry into gender care for children and young people within England’s National Health Service (NHS). NHS England commissioned the inquiry in 2020, under the leadership of Hilary Cass. The final report was published on 10 April 2024.
What it says
The report draws, among other things, on literature reviews by the University of York. It concludes that the evidence base for medical treatment of minors is weak and that the rationale for early puberty suppression remains unclear. The report recommends prescribing puberty blockers only as part of research, providing every young person with a comprehensive assessment that takes mental health and development into account, and organising care through regional centres.
Consequences
NHS England adopted the recommendations and is reorganising care for young people. In the Netherlands, the House of Representatives asked the government to respond; its response came in a parliamentary letter dated 4 June 2024. An analysis of how the report was covered in the Dutch press can be found on gendermedia.nl in the Cass Review in the Dutch media. An extensive discussion is available on the page about the Cass Review. The report also addresses the differences from the Dutch Protocol.
How the inquiry was conducted
NHS England commissioned the inquiry in September 2020. An interim report published in March 2022 described the existing model, with a single nationwide clinic, as neither safe nor sustainable. For the final report, Cass commissioned seven systematic literature reviews from the Centre for Reviews and Dissemination at the University of York. They cover the characteristics of referred young people, social transition, psychosocial interventions, puberty blockers, hormones, care pathways and clinical guidelines, and were published in the journal Archives of Disease in Childhood. The final report contains 32 recommendations. Regarding social transition in young children, the report advises caution because evidence is lacking. An attempt to collect data on approximately 9,000 former patients through adult clinics stalled because the necessary cooperation was not forthcoming. More information about this type of research can be found under systematic reviews in gender care.
Reception and criticism
British professional organisations such as the Royal College of Psychiatrists, the Royal College of Paediatrics and Child Health and the British Psychological Society responded favourably. By contrast, the international professional association WPATH criticised the report’s underlying principles. Yale Law School’s Integrity Project published a piece accusing the report of serious flaws in July 2024. In 2024, the council of the British Medical Association adopted a motion to publicly criticise the report and, following protests, adopted a neutral position pending its own evaluation. In March 2024, NHS England decided to stop prescribing puberty blockers outside research settings. An earlier British literature review is included in this archive under NICE Review (UK, 2020).