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Improving gender identity healthcare

Implications of the Cass Review for Scotland

A multi-disciplinary team established to consider how the recommendations in the Cass Review might apply to NHS services in Scotland has submitted its findings to the Scottish Parliament.

A senior clinical team, commissioned by the Chief Medical Officer for Scotland, considered all 32 recommendations of the Cass Review into Gender Identity Services for Children and Young People in NHS England. The team assessed to what extent they were applicable in the Scottish context, and whether they could be implemented in Scotland’s health service.

Recommendations of the multi-disciplinary team included:

  • a lead senior clinician, preferably a consultant, should take overall responsibility for each young person’s care
  • each care plan should include a full assessment of the child’s needs, both psychological and physical 
  • as elsewhere in the UK, the use of puberty-supressing hormones – commonly referred to as puberty blockers – should be paused until further clinical trials can be undertaken. NHS Scotland will continue to engage in the forthcoming UK study
  • work to design a regional service for children and young people should begin immediately, and services should ultimately be provided as locally as possible, based in children’s health services, with strong links between secondary and specialist services.

The conclusions of the report will now be considered by the Scottish Government – both in relation to how current services should be delivered to ensure service continuity, as well as on how these services should be commissioned in the future to ensure sustainable person-centred care.  

Deputy Chief Medical Officer Professor Graham Ellis said:

“The Cass Review was established to make recommendations on how to improve NHS England gender identity services for children and young people. Through this review we have aimed to set out which recommendations could apply to Scotland, and how they might be implemented.

“At the heart of this question are children and young people in distress, and our ambition must remain focused on meeting their needs with holistic, person-centred care as close to home as practical.

“The Cass Review identified the need to ensure that gender identity services for young people are more closely aligned with other areas of clinical practice, and that responsibility for the full range of services required should extend beyond specialist services. This will be essential as we seek to always provide the best possible care.

“In responding to the Cass Review, the multi-disciplinary team looked at the recommendations from a clinical perspective, always remembering that we have a responsibility to make sure that all children and young people grow up safe, respected and supported.”

Health Secretary Neil Gray said:

“The Scottish Government welcomes the multi-disciplinary team’s report, which has carefully considered the Cass Review’s recommendations and how they apply to Scotland. The conclusions of the report will now be considered and used to improve gender identity healthcare for children and young people. The Scottish Government will update Parliament after summer recess. 

“We remain absolutely committed, not just to ensuring ongoing support is available, but to reforming and improving gender identity healthcare across Scotland.”


Cass Review – Implications for Scotland - letter from Chief Medical Officer Professor Sir Gregor Smith to Convener of the Health, Social Care & Sport Committee.

Cass Review – Implications for Scotland report

The report highlights that the Cass Review was commissioned for an NHS England operational setting, while recognising that it comes from an appraisal of clinical, governance and scientific perspectives. Accordingly, it considered each of the 32 recommendations and how they do or do not apply in a Scottish context.

Of the 32 recommendations the team found the majority are either applicable or partly applicable.  Six were found not to be applicable to Scotland though, where appropriate, the team’s report has provided a perspective from a Scottish context.

In developing this response, the team sought views from relevant experts, commissioners, and clinicians, including Medical Directors in NHS Lothian and NHS Greater Glasgow and Clyde, clinicians in the current young people’s service, other clinicians including psychologists, psychiatrists and paediatricians, and Dr Hilary Cass and her Review team.

Pre-election rules prevented publication in the run-up to the UK General Election, but a commitment was made to parliament to publish at the first opportunity after the restricted period ended.

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