Doctors’ union will ‘critique’ Cass Review after criticising puberty blocker ban

The doctors’ union is to “critique” the Cass Review into children’s gender services and make recommendations to improve a healthcare system which it said has “failed transgender patients”.

The British Medical Association (BMA) said its evaluation of the review will “pay particular attention” to the methodology used to underpin the report’s recommendations.

Published in April and first commissioned in 2020, the report concluded that gender care is currently an area of “remarkably weak evidence” and young people have been caught up in a “stormy social discourse”.

Research by the University of York, carried out alongside the report, found evidence to be severely lacking on the impact of puberty blockers and hormone treatments, while the majority of clinical guidelines were found not to have followed international standards.

The review made 32 recommendations on how to ensure young people get a high standard of care which meets their needs in a way that is “safe, holistic and effective”.

The BMA has called for the implementation of the recommendations to be paused while the union carries out its evaluation, which it said will likely take the rest of the year to complete.

NSH England (NHSE) has rejected this suggestion, saying it has “full confidence” in the Cass Review final report and will soon publish a plan to bring in its recommendations.

The union said transgender and gender-diverse patients “should continue to receive specialist healthcare, regardless of their age” and repeated criticism of the ban on puberty blockers, calling instead for “more research to help form a solid evidence base for children’s care”.

In March, ahead of the review’s publication, NHSE confirmed children would no longer be prescribed puberty blockers at gender identity clinics outside clinical research trials.

In May emergency legislation preventing the prescription of puberty blockers from European or private prescribers and restricting NHS provision to within clinical trials was brought in by the then-Conservative government.

Campaigners claiming the so-called “banning order” was unlawful lost a High Court challenge earlier this month.

The BMA said members of its council recently voted in favour of a motion which asked the association to “publicly critique the Cass Review”, due to what it called “unsubstantiated recommendations driven by unexplained study protocol deviations, ambiguous eligibility criteria, and exclusion of trans-affirming evidence”.

Following publication of her report, Dr Cass spoke of the “disinformation” she said had been spread, calling criticism of her research “inaccurate” and “unforgivable”.

She said researchers had appraised every research paper that was involved in the Cass Review, but not all were deemed to be the high or the minimum level of medium quality to make the threshold for inclusion.

Of the “task and finish” group established by the union, the BMA’s chairman of council, Professor Philip Banfield, said: “It is vitally important we take time and care to get this work right.

“This is a highly specialised area of healthcare for children and young adults with complex needs, and as doctors we want to be sure they get the most appropriate care and the support they need.

“The task and finish group will make recommendations to improve the healthcare system that has, for too long, failed transgender patients.

“It will work with patients to ensure the evaluation invokes the old adage in medicine of ‘no decision about me without me’.

“It is time that we truly listen to this group of important, valued, and unfortunately often victimised people and, together, build a system in which they are finally provided with the care they deserve.”

An NHS spokesperson said: “Dr Cass spent four years gathering evidence for the most comprehensive report of its kind, and her expertise and advice has been invaluable in supporting the NHS to create a fundamentally better and safer service for children and young people.

“NHS England has full confidence in her report and we are committed to taking forward its recommendations.

“We will shortly be publishing our plan to implement the report’s recommendations and findings, which includes setting out scope for further research, so children and young people can receive the best-possible care.”

The BMA said the critique will be shared with its UK council at its January 2025 meeting.

A Department of Health and Social Care spokesperson said: “The Cass Review is a robust report backed by clinicians and firmly grounded in evidence.

“NHS England will be implementing Dr Cass’s recommendations so that children and young people get the safe, holistic care and support they need.

“We do not support a delay to vital improvements from the NHS to gender services.”