The Cass Review and Gender Identity Services
Motion to Autumn Conference 2024
Conference notes that
In 2020, NHS England commissioned the Independent Review of Gender Identity Services for Children and Young People (the Cass Review), chaired by Dr Hilary Cass, former President of the Royal College of Paediatrics and Child Health.
This was triggered by: a significant increase in referrals to the Gender Identity Development Service (GIDS) in England accompanied by a rapid change in the observed case-mix; a concomitant increased reliance on drug-based interventions, particularly the off-label (unlicensed) use of puberty blockers (GnRH analogues); a number of whistleblowing reports by GIDS professionals employed by the Tavistock and Portman NHS Trust.
The Cass Review commissioned experts at the University of York to conduct a series of peer-reviewed independent systematic reviews of existing evidence, and also new qualitative and quantitative research (p.17; p.54, paras.1.17-20, and FAQ). In addition Dr Cass coordinated an extensive programme of engagement with young people, parents, clinicians, advocacy groups and associated professionals.
The systematic reviews identified major gaps in the evidence base concerning: puberty suppression in the early stages of normal puberty, including its impact on gender related distress and mental health (pp.176-177, paras.14.21-29); the side-effects of puberty blockers on, for example, normal adolescent brain development (p.178, para.14.40) and bone density (p.178, para.14.43); the impact of masculinising or feminising hormones in those under the age of 18 (p.33, para.85).
The foreword of the final report noted that “we have no good evidence on the long-term outcomes of interventions to manage gender-related distress” (p.13).
NHS England has concluded that “there is not enough evidence to support the safety or clinical effectiveness of PSH [Puberty Suppressing Hormones] to make the treatment routinely available at this time.” NHS Scotland and NHS Wales have both welcomed the report.
The Cass Review’s final report, published in April 2024, made 32 recommendations relating to a number of different aspects of service provision including: service standards; understanding the client group and their needs and providing a holistic service; improving the evidence base; and organisational practice (pp.28-45, paras.50-168).
Professor Louis Appleby, DHSC’s adviser on suicide prevention, has reported that recent social media discussion of the impacts of restricting access to puberty blockers “has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide,” as such discussions risk “imitative suicide or self-harm, to which young people are particularly susceptible.”
Conference is concerned that
I. The professional and scientific legitimacy of the Cass Review and its conclusions have been called into question by some politicians and commentators, without any substantive basis.
II. The spreading of disinformation in this highly sensitive area heightens the distress of those in need of support, and potentially increases their risk of suicide.
Conference believes that all young people with gender dysphoria have a right to expect care and treatment based on rigorous scientific and clinical evidence, and that their long-term wellbeing and best interests should always be of paramount concern.
Conference welcomes
A. Ed Davey’s call for ”an open, mature debate” on gender-related issues.
B. The positive response of the incoming government to the Cass Report, and the confirmation from the Secretary of State for Health that a research program into puberty blockers is being established.
Conference calls on NHS England to implement the recommendations of the Cass Report in full and without delay.
—ENDS—
This motion is supported by the following Liberal Democrat members:
Dr. Richard Hopkins - member, Wrexham Liberal Democrats
Thalia Marrington - Councillor, Cornwall Council
David Barnsdale - English Council Rep; member, Kingston Liberal Democrats
Juliet Line - member, St. Ives Liberal Democrats
Rachel Barker - English Council Rep; member, Sheffield Liberal Democrats
Zoe Hollowood - Chair, Liberal Voice for Women; Federal Council member; English Council Rep; member, St Albans Liberal Democrats
Toby Keynes - English Council Rep; member, South-East Regional Exec; member, Brighton & Hove Exec
Richard Kirker - English Council Rep; member, Tower Hamlets Liberal Democrats
Gary Wilson - English Council Rep; member, North West Regional Exec; member, Liverpool Liberal Democrats
Deirdre Hoyle - member, Glasgow Liberal Democrats
Alison Eden - member, Newton Abbot Liberal Democrats
Anne Williams - Acting Chair of the Welsh Liberal Democrats Membership Development Committee
Dionne Daniel - member, Lewes Liberal Democrats
Iris Walker - Councillor, Aberdeenshire West Liberal Democrats
Claire Loneragan - member, Yeovil Liberal Democrats
Judith Bailey - Local Branch Chair, Southend Liberal Democrats
Nigel Scott - English Council Rep; member, Haringey Liberal Democrats
Sharon Cox - member, Taunton and Wellington Liberal Democrats
Mark Johnston - Federal Council; member, Reigate Liberal Democrats
Jane Vaus - member, Lambeth Liberal Democrats
Sammy Barry-Mears - Councillor, Dacorum Borough Council; Diversity Officer, Hemel Hempstead Liberal Democrats
Lara Pringle - Councillor, Dacorum Borough Council
Imogen Beattie - Treasurer, Rutherglen Liberal Democrats
Edmund Jankowski - English Council Rep; member, St Albans Liberal Democrats