The NHS has set out plans for a review into the safety of adult gender services in response to detailed concerns raised by the authors of the Cath report into gender care for children and young people.
In a strongly worded letter to NHS England, leading paediatrician Dr Hilary Cass listed 16 concerns about the quality of care being offered to adults with gender dysphoria.
In response, NHS officials: review The company announced these services and said testing at the clinic will begin in September.
Cass said that over the course of her three-year review of child gender services, she was consulted by several staff working in adult gender clinics, who reported issues including poor consent procedures, inadequate explanation of the risks associated with treatment, “confusing” management procedures, “out-of-control waiting lists,” a “lack of national treatment guidelines for hormone use” and a “lack of systematic processes for follow-up.”
He was told that patients were not always informed “that some effects” of their treatment were irreversible. In a letter sent in May and published on the NHS England website earlier this month, Cath wrote that some clinicians had told him they were concerned that colleagues were not correcting or challenging patients’ “magical thinking” – “unrealistic beliefs about what can be achieved through medical transitions”.
Following these reports, NHS England has published details of a new review led by Dr David Levy, which will “assess the quality (i.e. effectiveness, safety, patient experience) and stability of each service, as well as whether existing service models are still appropriate for the patients they care for”.
Mr Levy, an oncologist who is medical director for Lancashire and South Cumbria Integrated Care Board, will be supported by expert clinicians, patients and representatives from the Care Quality Commission.
NHS England also published details of plans to expand services for young people, strengthen workforce training, improve research and explore offering support to patients who want to reverse their gender treatment or de-transition.
Cass wrote that she had heard concerns from some clinicians working in adult gender services that the approach to care was “ideologically driven and polarised, making it difficult to question the approach or discuss concerns”.
“A common concern was the very limited time available for evaluation and the expectation that patients would be on hormone treatment by the second appointment,” she wrote. “This limited evaluation was insufficient as the majority of patients’ symptoms were extremely complex, including a mix of trauma, abuse, psychiatric diagnoses, past forensic medical histories, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD).”
“Concerns were raised about the significant change in the case mix from one dominated by older men registered at birth to one dominated by women in their early 20s with complex symptoms,” she wrote.
The Cass report on child welfare services, published in April, recommended “follow-up services” for young people aged 17 to 25 to avoid them being moved directly into a radically different adult service model.
The Cass report was welcomed by both Labour and the Conservative parties, as well as NHS England, when it was published, but the British Medical Association last month voted in favour of a motion criticising the review and calling for a moratorium on implementing its recommendations.
A spokesman for the Cass Review defended its research standards.
