Why is the NHS ignoring the Cass Review?

The Cass Review was supposed to be the final word on a major medical scandal. Dr Hilary Cass’s report into the NHS’s youth gender-identity clinics should have called time on the experimentation on children who are confused about their gender. Yet it seems to be business as usual in at least one of the new clinics set up to replace the disgraced and now decommissioned Gender Identity Development Services (GIDS) at the Tavistock clinic in London.

Nottingham Young People’s Gender Service was founded in April to take on the backlog of former GIDS patients. Sitting within the larger Nottingham Centre for Transgender Health, the new centre is supposed to be part of a radical plan to offer holistic support to children, rather than simply affirming their identities and doling out drugs.

Yet it seems this new service is infested with gender zealots. In a job ad for a clinical psychologist posted last week, the centre says it is looking for someone who will ‘practise in a gender-affirming manner in line with’ guidance laid out by the controversial group, World Professional Association for Transgender Health (WPATH). This includes recommendations that there be no minimum age for a child to transition, as well as lowering the age for puberty blockers and even surgery.

This is hardly a surprise when you look at the centre’s senior medical staff. One top doctor at the clinic is Dr Walter Pierre Bouman, a past president at WPATH. Another leading mental-health doctor, Professor Jon Arcelus, was formerly a co-chair of the committee responsible for developing controversial WPATH guidance, which recommended surgical castration for men and boys who identify as ‘eunuchs’. Bouman and Arcelus are both consultants at Nottingham Centre for Transgender Health and as such will have a hand in what happens to the young patients transferred from GIDS.

The shockwaves from the Cass Review were felt around the world last year, as health bodies rapidly began to stop the routine prescription of puberty blockers. Nevertheless, on the day the review was published, I warned on spiked that ‘there are transgender activists at every level of the health service’. Because of this, there was always a strong possibility that ‘NHS employees might simply dismiss the Cass Review as politically motivated transphobia and attempt to ignore it’.

This has unfortunately proved to be the case. Cass has faced opposition from institutions such as the British Medical Association, which dismissed her report out of hand, and also from WPATH-affiliated employees who are embedded in NHS gender services. For example, Bouman from the Nottingham Centre for Transgender Health questioned Cass’s expertise. Shortly after the review was published, he posted on LinkedIn that she ‘has never treated trans youth, nor is she a researcher of any significance, yet her “expert” review provides supposedly “evidence-based” recommendations’. He added that there is ‘a fine line between naivety, narcissism and psychopathy’. Notably, the Nottingham centre was one of six adult clinics that refused to participate in the Cass Review’s research or to provide information.

Despite protestations from the likes of Bouman and Arcelus, Cass’s findings were undeniable. The evidence points only one way: there is no proven benefit to taking drugs to suppress puberty. There are, however, many serious harms, from damaged fertility to lowered IQ. Cass did allow for a clinical trial to monitor the efficacy of puberty blockers, perhaps to assuage fears surrounding a ban. Parents were, after all, regularly warned by trans activists that their child might kill themselves if they do not gain access to these drugs.

However, this clinical trial is nothing but bad news. Cass told BBC Radio 4’s Woman’s Hour earlier this month that there would be no limit on the number of young people who got into the trial. It is hard to see how this differs from the original experiments at the Tavistock. After all, the widespread off-label use of puberty blockers that hastened the closure of GIDS expanded from just such a clinical trial.

The closure of GIDS felt like the end of a nightmare. Many of those who had spent decades warning that children were being experimented on breathed a sigh of relief. But the shift to regional centres, like the service in Nottingham, has not ended the medical abuse of children. Nor has it dampened the enthusiasm of trans zealots within the NHS.

Jo Bartosch is a journalist campaigning for the rights of women and girls.