LGBTQ+ experts criticise Cass Review in open letter to Health Secretary Wes Streeting

More than 100 organisations and activists have signed an open letter condemning the Department of Health’s continued “degrading” of trans healthcare by implementing the Cass Review.

The letter, published on Tuesday (15 October), expresses a “deep lack of confidence” in the review, which made recommendations on how to improve trans youth care in England and Wales, as well as “concerns” over government support for it.

“Trustworthy government review of the evidence base for a particularly controversial policy, especially in the medical field, do not look like the Cass Review,” the letter, headed by the charity TransActual, reads.

“They have a clear mandate and problem to solve which are raised by those directly affected, not by newspaper columnists or ideologues. They do not exclude members of the patient cohort and those with long-term experience in the field from being part of their team or consider professional or lived experience
“bias”.

Written to health secretary Wes Streeting, the letter describes the report as an “absurd spectacle” which makes recommendations that “undermine trans people’s care by fear-mongering about the number of young people who seek to use it”.

The report, published in April, made upwards of 32 recommendations to implement what Dr Hilary Cass described as a “holistic approach” to treatment.

Several of these recommendations, which include separating pathways for pre-pubescent children and teenagers, exercising “extreme caution” on puberty blockers, and creating a follow-through service for those aged between 17 and 25, have been subject to scrutiny by charities, not-for-profit groups and medical organisations.

The British Medical Association’s (BMA’s) council chairman, Philip Banfield, said in August that it was “vitality important” to scrutinise the report, especially given the “complex” nature of trans healthcare.

The BMA has since announced a review of the report, recommending that its implementation be put on pause while that is happening.

Among the criticisms highlighted in the open letter are the selection of Hilary Cass “without consideration of any other candidates,” the “secrecy” surrounding the report’s commissioning by NHS England, the lack of transparency in the research involved in making the decisions, and the “explicit exclusion of any trans people from involvement in the Governance Assurance Group, on the basis of potential bias”.

The last of these, the letter claims, goes against the NHS principle of “nothing about us without us”.

It goes on to say: “The technical failings of the Cass Review have been extensively documented. There is a real concern, therefore, that the review promotes an inherently flawed approach to determining the efficacy and safety of clinical support for trans healthcare.

“It is worrying that Baroness Cass [who was elevated to the House of Lords in August] has found it necessary to deny her colleagues’ accusations of bias against trans lives and trans culture, especially since other concerns about her leadership of the review have been expressed.”

The letter, signed by prominent trans activists and academics including Helen Belcher, Dr Natacha Kennedy, Stewart O’Callaghan, and the New Road Parents support group, finishes by recommending that Streeting suspends the implementation of the report immediately, as well as support the BMA’s review.

Share your thoughts! Let us know in the comments below, and remember to keep the conversation respectful.