Dr Hilary Cass has published her long-awaited review into support and treatment offered to children who claim they are transgender, with the paediatrician warning that the wider social debate on this issue remains “exceptionally toxic”, and “there are few other areas of healthcare where professionals are so afraid to openly discuss their views”.
The Cass Review offers a strong – some would say unanswerable – challenge to the ‘gender affirmative model’ which in recent years has become the norm in the NHS’s Gender Identity Development Service (GIDS). Faced with cases of gender distress, this approach encourages clinicians to ‘affirm’ rather than question a child’s chosen gender identity, before then putting them on a medical pathway that can have lifelong, irreversible consequences.
The Report cautions that extreme care should be taken before anyone under the age of 25 transitions; calls for an end to the prescribing of puberty blockers and cross-sex hormones to under 18s; warns that children who change gender may regret it; finds that many gender confused adolescents have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term benefits of the treatments that have been given to children.
In other words, the days of NHS England handing out puberty blockers “as if they were sweets”, as Kathleen Stock once put it, look to be numbered.
So is the battle for evidence-based medicine in the treatment of gender confusion amongst children and young people now won?
Equalities Minister Kemi Badenoch isn’t so sure.
“Sadly, this is not the end of the matter, merely the beginning,” she writes for the Times. Ms Badenoch continues:
I set out some of the evidence in a letter to the women and equalities select committee that many trans-identifying children turn out to be gay or autistic and do not always retain the identity into adulthood. Yet, again and again we have been confronted with institutional resistance.
Cass has made important recommendations but they are largely focused on managing NHS services better. None of this will happen until we address the underlying problem of ideological capture. It has become almost impossible to question fashionable theories if they are promoted under the banner of progressivism or social justice. Dissent is treated as evidence of bad faith, bigotry or a lack of intellectual sophistication.
This is why I am cautious about celebrating victory too early. There is plenty of evidence that Stonewall and its allies are simply hoping for a change of government before continuing with their crusade. They misrepresent the law, pretending it says what it does not, and they will misrepresent the Cass report.
Over three decades, politicians of all parties have outsourced power to so-called independent institutions. They were meant to take the politics out of decision-making but have themselves become politicised often with little to no ministerial oversight. They are no longer impartial. As politicians ceded control, many institutions became captured by a minority of ideological activists.
Those who first publicly questioned the tenets of gender ideology were subjected to hysterical abuse and calumny. Brave people including Kathleen Stock and Graham Linehan were hounded out of their jobs. James Esses lost his role at Childline. The Labour MP Rosie Duffield was harassed by her own party members and fellow MPs while Starmer looked away.
Worse than the ravings of the militants was the cowardice of those in positions of influence. How many university administrators, media editors, police officers and politicians preferred to keep quiet for fear of becoming the next target or in the hope of maintaining their progressive credentials?
We need more bravery and less cancel culture.
At the heart of the Cass review is a failure of institutions to self-regulate. Ministers have intervened time and again but it is now time for leaders to step up and recover impartiality. It is time that the clinicians who refused to co-operate with Cass were held to account.
