Cass Review Final Report: METRO Charity's initial statement

Our initial response to the Cass Review's final report on gender identity services for children and young people, published this week.

First and foremost, we believe that every child and young person deserves high quality, holistic, personal and timely healthcare on the NHS. This includes trans, non-binary and gender-diverse young people and children.

The Cass Review is an independent review of NHS England gender services for children and young people. It was commissioned by NHS England and has been chaired by Dr Hilary Cass. This week, Wednesday 10th April 2024, the Cass Review published its final report, which runs to almost 400 pages.   

We cautiously welcome the publication of the report itself, which has taken almost four years. We are pleased that the Cass Review recognises the necessity of holistic healthcare on the NHS, and appreciate its role in highlighting how the current NHS system is failing trans and gender-diverse young people. 

There were a number of beneficial recommendations within the report, such as: for more thorough training for medical professionals; setting up a series of regional centres to support trans and gender-diverse young people; and recognising that there is no ‘one size fits all’ when it comes to medical practice in this area.  

However, there were also areas which caused some concern. The report risks interpreting factors such as being neurodiverse, bullied or experiencing mental health difficulties as being probable causes for gender dysphoria, outside of a person being trans or non-binary. A more intersectional approach would embed the fact that people can and do experience multiple, overlapping identities at once. We know from our work with METRO GAD that Disabled people are far too often overlooked in decisions about their own medical care, autonomy and independence. We know from our work supporting LGBTQ+ children and young people that homophobic and transphobic bullying is far too common an experience. We know from our mental health work that experiencing prejudice often creates mental distress. However, none of these experiences are mutually exclusive from a young person being trans or non-binary.  

Joel Robinson, METRO's Acting Co-CEO stated: 

"Despite some of the positives in the final report, we feel that the main story of NHS care for young people and adults who are trans and gender-diverse is that we face long waiting times, inadequate and untailored services, and are fighting to access medical care within a system that seems to pathologise us. We deserve better and should have been consulted more during this review. 

"We also urge all parties to continue listening and responding to the voices and experiences of trans and gender-diverse young people, and to place Dr Cass’ plea at the forefront of their actions “to remember the children and young people trying to live their lives and the families/carers and clinicians doing their best to support them. All should be treated with compassion and respect.” 

As we at METRO take time to fully digest the contents of the report, we call on NHS England, NHS services across the UK, and policy-makers to do the same, ensuring they do not immediately succumb to pressures to implement further limitations on trans and gender-diverse young people’s access to healthcare.   

We will release a further statement once we have had the opportunity to fully absorb and analyse the contents of the Cass Review’s final report.