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Cass Review
15 April 2024
Lead MP
Victoria Atkins
Debate Type
Ministerial Statement
Tags
NHSTaxationWomen & EqualitiesMental Health
Other Contributors: 39
At a Glance
Victoria Atkins raised concerns about cass review in the House of Commons. A government minister responded. Other MPs also contributed.
How the Debate Unfolded
MPs spoke in turn to share their views and ask questions. Here's what each person said:
Government Statement
The Minister Victoria Atkins stated that the Cass review has exposed a myth within the NHS's gender identity services for children, where cultural values had overshadowed evidence-based care. She highlighted an exponential increase in referrals to gender identity clinics since 2009—from fewer than 60 in 2009 to over 5,000 by 2022—with a significant proportion being teenage girls. The review found that clinicians often prescribed irreversible treatments such as puberty blockers and cross-sex hormones without fully considering the children's broader needs or conditions. Atkins thanked Dr Hilary Cass and her team for their comprehensive review and outlined several measures taken since the interim report's publication, including closing the Tavistock clinic, opening new regional hubs, stopping routine prescriptions of puberty blockers to under-18s, and prohibiting children from being seen by adult gender services. The minister warned against private providers attempting to prescribe such treatments and pledged legislative action if necessary. She also addressed the lack of robust data on long-term outcomes and outlined steps to ensure compliance with the Cass review's recommendations.
Question
The MP's question or point. Include their concern, local impact, or criticism. 2-4 sentences.
Minister reply
The minister's response to THIS specific MP. Include commitments, rebuttals, details. 2-4 sentences.
Wes Streeting
Lab
Ilford North
Question
The MP thanked the Secretary of State for her statement and Dr Hilary Cass's review. He highlighted issues such as long waiting times, shaky evidence for interventions, and NHS providers refusing to co-operate with the review. The shadow response called for shorter waiting times, follow-through services up to age 25, regulation of private clinics, data sharing from adult gender services, and a less toxic debate around the issue.
Minister reply
The Minister welcomed those who have changed their minds on this critical issue and acknowledged the hurt caused by past ideological positions. She emphasised the need for a new approach to ensure patient safety and better care for children and young people.
Question
The MP questioned the governance failures highlighted in the report, particularly regarding NHS England's specialist commissioning process that allowed unchecked expansion of treatments. She also mentioned the Tavistock clinic's popularity leading to governance issues and asked what measures would be taken to prevent such issues in future.
Minister reply
The Minister thanked the MP for her contributions and acknowledged concerns about past practices. She noted that the Tavistock clinic has shut, and new services with multidisciplinary approaches are being developed across the country.
Kirsten Oswald
Lab
Dudley South
Question
Nobody’s identity should be up for debate and must not be used as a political football. Polarisation does nothing to help young people in accessing care, their families or NHS staff. Does the Secretary of State agree that we must remain respectful at all times when discussing these issues? Can she confirm whether additional funding will be made available to ensure quality healthcare access for young trans people and provide an update on legislative proposals on banning conversion practices based on the Cass review?
Minister reply
The SNP and Labour are encouraged to respond quickly to the findings of the review in their respective devolved areas. The NHS England budget is being re-prioritised within existing funds, not requiring additional Barnett funding. The atmosphere of debate has been negatively influenced by certain actions and legislative decisions in Scotland. More than £17 million has already been committed to two new hubs for specialist services.
Caroline Nokes
Con
Romsey and Southampton North
Question
What concerns does the Secretary of State have regarding capacity for expanded services for 17-25 year-olds and possible impact on other areas of healthcare? Could there be an interim service to address the transition from children’s to adult services, and will more funds be committed?
Minister reply
Concerns exist about the capacity to handle young people transitioning between children's and adult services. NHSE is focusing on this cohort and developing work to mitigate issues faced by this vulnerable group. Over £17 million has been committed to two new hubs, with expectations that devolved Administrations will commit similar sums.
Nia Griffith
Lab
Llanelli
Question
What are the plans for expanding multi-site centres and when is this likely to happen?
Minister reply
Plans include expansion to Bristol later in the year, with further sites across England. The aim is not just specialist services but also empowering clinicians to treat the whole child rather than focusing solely on gender identity issues.
Caroline Johnson
Con
Sleaford and North Hykeham
Question
Who blocked research data that would have given a better understanding of outcomes for children, what investigations will be carried out to find out who was responsible and how they will be held accountable?
Minister reply
The Minister is working on this issue at pace and will update the House once she has more information. Expectation exists for clinicians and medical professionals to act in accordance with evidence-based guidelines, and regulators are expected to hold individuals accountable.
Rosie Duffield
Ind
Canterbury
Question
Does the Secretary of State agree that those who have raised concerns over the past few years about safeguarding vulnerable children should be owed an apology for being no-platformed and sidelined, and are they now vindicated by Dr Cass’s review?
Minister reply
Admiration is expressed towards Labour Members for their commitment despite facing demeaning treatment. This is a moment for apologies and humility to ensure that questions about the medical treatment of children can be asked in an atmosphere of respect.
Miriam Cates
Con
Hinckley and Bosworth
Question
Welcomed the Cass review, criticised GIDS for its unethical practices, questioned how to prevent such scandals in the future.
Minister reply
Acknowledged criticism from Labour Party members regarding trans-exclusionist groups, emphasised need for clinicians to follow report recommendations.
Christine Jardine
Lib Dem
Edinburgh West
Question
Asked about the impact of the toxic debate on staffing and recruitment issues in GIDS.
Minister reply
Emphasised need for holistic care, expressed concerns over past mental health issues being neglected.
Paul Bristow
Con
Consett
Question
Asked about the Secretary of State's reaction to gender clinics refusing to cooperate with Cass review and their attitude towards following Government guidance.
Minister reply
Expressed disgust at non-cooperation, emphasised importance of public institutions adhering to report recommendations.
Dawn Butler
Lab
Brent East
Question
Critiqued the Cass report's impact on trans people and requested funding for holistic healthcare pathways.
Minister reply
Responded ambiguously, noted support from NHS for implementing report recommendations.
Jason McCartney
Con
Colne Valley
Question
Asked about steps to address mental health deterioration in young people and support for child and adolescent mental health services.
Minister reply
Acknowledged the need for crisis prevention and rollout of mental health support teams.
Sammy Wilson
DUP
East Antrim
Question
Complimented Dr Cass's report and inquired about steps to purge transgender lobby from NHS, and cross-government discussions.
Minister reply
Stated need for implementation of reforms at individual and organisational levels within NHS.
Guildford
Question
Expressed thanks for Cass review and inquired about implications on conversion therapy ban.
Minister reply
Acknowledged the need to avoid unintended consequences, emphasised consideration of independent Cass review.
Tonia Antoniazzi
Lab
Gower
Question
The starting point of all modern medicine must be robust and reliable evidence. The hon. Member has been raising concerns about the treatment of transgender individuals since 2017, emphasising that data is crucial to inform decisions regarding healthcare for children.
Minister reply
Acknowledging the journey the hon. Lady has undertaken on this issue, the Minister expresses a desire for a clean slate moving forward, prioritising child-centric services over past debates. She emphasises the need to move beyond toxic discussions and work constructively towards implementing the Cass report's recommendations.
Question
The hon. Member calls for an inquiry into the issue affecting at least 9,000 children and requests reforms in both NHS services and school safeguarding measures to address current guidance that downplays risks related to gender identity issues.
Minister reply
Acknowledging the importance of addressing this issue, the Minister states her focus on implementing recommendations from the Cass report rather than immediately establishing a public inquiry. She commits to working with Education colleagues to improve statutory safeguarding guidance.
Question
Welcoming the statement, the hon. and learned Member emphasises that whistleblowers were defamed for raising concerns about ideological capture in institutions like the NHS, urging support for a public inquiry once recommendations are implemented.
Minister reply
Expressing gratitude to the hon. and learned Lady for her efforts, the Minister states her intention to ensure Cass report recommendations are applied across all parts of the UK, including Scotland, Wales, and Northern Ireland.
Question
The hon. Member welcomes the report's emphasis on the welfare of young people, asking if the Secretary of State will ensure that findings are implemented across government sectors such as education and social services.
Minister reply
Acknowledging the need for a cross-government approach, the Minister commits to ensuring implementation of Cass report recommendations in health sector while also advocating for depoliticization of public space.
Question
The hon. Member welcomes the research but emphasises the lack of evidence regarding large-scale success or regret among transgender youth and calls for more longitudinal studies to support healthcare pathways.
Minister reply
Responding with disbelief, the Minister references a previous debate where the hon. Gentleman's behaviour was seen as inappropriate. She suggests that setting an example is key to addressing toxic debates.
Douglas Ross
Con
Dundee East
Question
The Scottish Government’s response to the Cass review has been one of deafening silence. What discussions have there been on this issue, if any, between Scottish Government Ministers and the UK Government?
Minister reply
I thank my hon. Friend for his careful and considered question. I very much hope that the SNP Government will look at the evidence carefully and find the recommendations to their liking. The Hate Crime and Public Order (Scotland) Act 2021, brought forward by the Scottish National party Government and supported by Scottish Labour, cannot help the considered debate about this complex subject.
Emma Hardy
Lab
Kingston upon Hull West and Haltemprice
Question
Does the Minister agree that making jokes about trans people and trans children is cruel and moves focus away from ensuring young people get the help they need?
Minister reply
True leadership is not just about being careful with words. Trans prisoners, including those who are fully intact and have been convicted of serious sexual offences, are demanding to be held in prisons that match their chosen gender.
Bill Cash
Con
Stone
Question
Does the Minister believe administrative rule changes will resolve this issue or is it about changing legislation like the Equality Act 2010?
Minister reply
The brevity of my answer demonstrates my respect for the observations and experience of my hon. Friend. I completely agree with him, and I will enjoy working with him on this.
Neale Hanvey
SNP
Dunfermline and West Fife
Question
What support will the Secretary of State provide to have a conversation and weed out gender ideology elsewhere?
Minister reply
I thank the hon. Gentleman for his advocacy on this issue. I very much hope that all Members will be able to use the evidence produced in this review and report in future debates about legislation so that we can all make informed and correct decisions.
Lia Nici
Con
Brent North
Question
What is she going to do to ensure people pushing gender ideology are now on the sex offenders list and taken off practising as medical professionals?
Minister reply
I thank my hon. Friend for that. She is right to emphasise that this is about not just the debate within the NHS, but what happens online. Parents of children affected by this are very aware of the online “grooming” of children on social media.
Battersea
Question
Does the Secretary of State agree that the review of adult gender services should take into account the number of patients with mental health challenges and what additional resources will be put in place for mental health provision?
Minister reply
I thank the hon. Lady for her thoughtful question. The financial value of the contract last year with the Tavistock was £9.3 million, but for this financial year NHS England has committed some £17.1 million for two new hubs for gender services.
Richard Fuller
Con
North Bedfordshire
Question
Will my right hon. Friend be looking at ways in which there is room for people to be struck off if found to be wrong, managers sacked and legal action taken?
Minister reply
I completely understand my hon. Friend’s desire for accountability. I just remind us all that some clinicians have acted in a morally exemplary way, trying to blow the whistle on practices they observe.
Kim Johnson
Lab
Liverpool Riverside
Question
Will the Minister join me in challenging NHS England’s specialised commissioning team on its immediate limiting of access to support for 17-year-olds and call on it to immediately reinstate access?
Minister reply
I hope the hon. Lady will forgive me if I have misunderstood her question, but I think she is referring to the decision that NHS England will prevent under-18s from accessing adult gender services. A consultation has just closed and we are looking at the results of that.
Julie Marson
Con
Devon, Teignbridge
Question
My experience of speaking to my constituents on this subject has been characterised by fear—it is often the fear of mothers about their daughters, the fear of what is happening to their children and the fear of speaking out because of the group-think and the toxicity of the debate. Does my right hon. Friend agree that Dr Cass’s extensive, evidence-based report should mark an absolute turning point, in ensuring that we spearhead our approach to this debate by putting children first and being non-ideological in all areas—across Government, in all Departments, not just the NHS, in education and in our public bodies?
Minister reply
I thank my hon. Friend sincerely for that. Again, she articulates the concerns of many families where a teenager or young person may be suffering complex needs and are asking questions of themselves and their place in society. We must treat not just the child or young person, but the family with care and respect, trying to support them to get to the right place for the child.
Chi Onwurah
Lab/Co-op
Newcastle upon Tyne Central and West
Question
Some constituents who have contacted me see in the Cass report a vindication of their long-held views on sex and gender following years of abuse, sometimes violent. Others who have contacted me fear that the Cass review represents an attack on their very existence as trans people and fear the abuse to come. Will the Secretary of State set out that she opposes utterly the toxification and politicisation of questions of sex and gender? Will she also set out that she will collect the additional evidence that the Cass review calls for, without which there cannot be an evidence-based approach? Will she also set out that she will put in place the resources our young people need in terms of healthcare to ensure that they receive the healthcare appropriate to them?
Minister reply
I thank the hon. Lady for giving me the opportunity to make it clear again that this report is about gathering the evidence to help support our children and young people to the best care they can have. For a very small number that may well be a medical pathway, but for the overwhelming majority we know from Dr Cass’s report that there may be other ways in which they can be best supported and looked after.
Anna Firth
Con
Eastleigh
Question
I welcome the Secretary of State’s powerful statement and the Cass report. However, we have to acknowledge that the report would not have been commissioned without this Government, with the support of some other parties. So many Opposition Members just stayed silent and thought the report was pretty much a waste of time, and to see the lack of any appreciation of that today is shocking and shameful.
On the timetable to enact the wider findings of the Cass report, I am grateful for what the Secretary of State said about meeting the GMC over the weekend, but there is work to be done. Secondly and really concerningly, what steps are—
Minister reply
My hon. Friend’s observations about Members from other parts of the Chamber and their response to this are well made, frankly. [Interruption.] Gosh, I am being told they are not true. Crikey, Opposition Members may have just opened up a Pandora’s box. On my hon. Friend’s point about supporting people who have gone through the process and are trying to detransition, she is absolutely right that they need particular care. I am actively looking into what NHS England needs to provide to look after the very complex needs that such people have.
Ben Bradshaw
Lab
Exeter
Question
Has the Secretary of State seen today’s very sad interview with Judge Victoria McCloud, Britain’s only senior transgender judge, who has been driven from her job because of anti-trans hate, particularly the trend among some politicians and opinion formers to describe being transgender as “an ideology”? The Secretary of State has used the term “ideology”, as have a number of her colleagues, during this statement. For the benefit of the House and trans people, will she clarify that she does not believe that being transgender is “an ideology”?
Minister reply
I genuinely thank the right hon. Gentleman for giving me the chance to re-emphasise that. When I have talked about ideology, it is the ideology influencing or making assumptions about the provision of services for any child or young person who is questioning their place, sexuality, identity or future path in life. The ideology is the one that influenced the services that Dr Cass has set out so very well.
Robin Millar
Con
South Dorset
Question
I welcome this statement. The Cass report highlights the area of prescribing untested and irreversible drugs as puberty blockers to young people, but in Wales the pathway for young people diagnosed with gender dysphoria includes referral to gender services in England. The Cass report also warns against teachers being forced into making premature and effectively clinical decisions about affirmation, such as social transitioning, and yet that is implicit throughout the Welsh Government’s LGBTQ+ action plan and their compulsory relationships and sexuality education curriculum. Does the Secretary of State agree that these findings have relevance for the safeguarding of children in England and Wales? Does she agree that parents, teachers and health workers across England and Wales can expect politicians to take heed of these findings?
Minister reply
I very much agree with my hon. Friend. He is always very good at exposing the differences in treatment that patients in Wales receive compared with those in England. Given that the leader of the Labour party has said that Wales is the “blueprint” for how it plans to run the NHS in England, I hope and expect that the Labour party will be true to its word and the Labour-run NHS in Wales will be announcing its immediate adoption of these recommendations, as well as the transformation to services that we in England are already undertaking.
Stella Creasy
Lab/Co-op
Walthamstow
Question
Many of us recognise the value of the Cass report, as my hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) set out, in its call for evidence and a thoughtful approach, and its recognition that the collapse of child and adolescent mental health services has contributed to the difficulties in children accessing services. However, I stand here today with terrified constituents who are part of the backlog. I dare say that thousands of those children have been watching this debate with their families and are frightened to hear the heat, not light. The Secretary of State has a brief in front of her, so can I ask her a practical question for my constituents who do not understand what this will mean for waiting times and delays? She said that she was not putting any new money into the service but funds were being reprioritised. In practical terms, what will that mean for those young people who are trying to navigate what is happening to them, who need our support and care, not the derision of any political movement?
Minister reply
I refer the hon. Lady to the answer I gave earlier about funding. In relation to the waiting list, we have already removed the Tavistock as the single provider of these services. We have now set up two sets of services in highly respected—world-respected—children’s hospitals, and we will add more. Again, the issue goes back to giving GPs and other practitioners the confidence to look after these children as they would if they were presenting solely with, for example, ADHD symptoms or concerns about mental health.
Rother Valley
Question
Providing hormone blockers to children is wrong; encouraging and giving cross-sex hormones to children is wrong; and encouraging breast binding for children is wrong. In the future, I believe we will look back on this scandal—and it is a scandal—with incredulity about how we did this to our children, especially our girls. We should all be embarrassed that this is the situation we are in. It is not just carrying on in our hospitals and the medical profession; this sort of ideology is going on in our schools. Does the Secretary of State share my concerns and those of my constituents, who have raised the issue with me in private because they cannot raise it publicly, that a school in Rother Valley is fundraising for Mermaids, a charity that is accused of encouraging young people to transition simply because they do not confirm to gender stereotypes, even though they are too young to understand the consequences? Does the Secretary of State share my belief that Mermaids and other such charities have no place in our schools, and no place to help to hinder our children?
Minister reply
I thank my hon. Friend, and I will set out the practical and important steps NHS England has already taken, which I hope other parts of the United Kingdom will follow. NHS England has banned the prescription of puberty blockers for gender dysphoria to children under the age of 18. On the advice of Dr Cass, cross-sex hormones can be prescribed only with extreme caution for those aged 16 and older.
Question
I welcome the Cass review. Its recommendations merit proper and full consideration. Dr Cass has called for young trans people, their families and clinicians to be treated with respect and compassion. Sadly, we have not seen that today in some of the comments and heckles that have been made during the statement. Will the Secretary of State commit to challenging the harmful culture of transphobia in the UK?
Minister reply
If the hon. Gentleman wants to work constructively with me on ensuring that we deal with this report and the evidence in a caring and careful way, for the benefit not just of children and young people but of the wider trans community, I would welcome his support in so doing.
Zarah Sultana
Your Party
Coventry South
Question
Although I welcome the call from Dr Cass for all young people, including young trans people, to be treated with compassion and respect, I share concerns about important elements of the review, particularly given the context in which it was published. Last year, transphobic hate crimes hit a record high. A United Nations report noted deep concern about the increase in harassment, threats, and violence against LGBT people in the UK. Will the Minister join me in condemning the rise in transphobia, in acknowledging that trans rights are human rights, and in recognising that we will only deliver high-quality healthcare that everyone deserves when we respect the rights and dignity of all?
Minister reply
Not only have I tried to espouse those principles in every ministerial role that I have held, but it is the guiding light of this Government to try to ensure that we get the right healthcare and support to patients as quickly as possible. We also want to ensure that we are treating not just the condition, but the patient as a whole. The children and young people who are the focus of this report have to be, and will be, the focus of our work going forward.
Jim Shannon
DUP
Strangford
Question
May I thank the Secretary of State for her fortitude and determination, and Dr Cass for all her endeavours? Both ladies have been incredibly impressive and capable. We should be taking on board Dr Cass’s report in Northern Ireland. What help and support is available for all those patients who have been in the Tavistock since its inception? Importantly, what steps can be taken by the Government to stop this malpractice and to stop the movement of the vulnerable into privately funded abuse?
Minister reply
Let me offer the hon. Gentleman my sincere apologies; I am out of practice and should have known that his would be the last question. The hon. Gentleman makes a point about private practices. That is one area that I am working on at pace. What we do not want is to have any idea forming that somehow people can get round the strict rules that the NHS is setting the system to get these drugs to young people and children.
Shadow Comment
Wes Streeting
Shadow Comment
The Shadow Secretary of State, Wes Streeting, thanked Dr Hilary Cass for her thorough work and acknowledged the complex and sensitive nature of the issue. He highlighted the scandal that children and young people are waiting far too long for care while their wellbeing deteriorates, and medical interventions were made on shaky evidence. Labour welcomed NHS England's decision to stop routine prescriptions of puberty blockers but raised concerns about private clinics circumventing these rules. Streeting asked how the Secretary of State plans to cut waiting times for mental health assessments, establish follow-through services up to age 25, ensure compliance with data sharing from adult gender services, and address the toxicity of public debate that has made it harder for healthcare professionals to do their job.
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