Sunak urges ‘extreme caution’ after review criticises NHS gender identity care

Stay informed with free updates

Simply sign up to the Social affairs myFT Digest — delivered directly to your inbox.

UK Prime Minister Rishi Sunak has called for “extreme caution” when treating children seeking gender identity care in the NHS after a report warned there was “remarkably weak evidence” surrounding medical interventions.

An independent health service review published on Wednesday found the “pillars” of gender medicine were “built on shaky foundations” and that children questioning their identity had been let down by a lack of research, as well as “toxicity” in the debate around changing gender.

“We need to exercise extreme caution when it comes to these issues,” Sunak told LBC radio on Wednesday morning. “We care above all about the wellbeing of children and it is clear that these things are not neutral acts, whether that is social transitioning, any kind of medical intervention, we simply do not know the long term effects of these things.”

A review of gender identity services by Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, was commissioned in 2020 after an increase in young people approaching the NHS.

In her 400-page report, Cass found “remarkably weak evidence” about the use of hormone treatments and puberty blockers, as well as “no good evidence on the long-term outcomes of interventions to manage gender-related distress”.

The NHS has been prescribing puberty blockers since 2011, but in March it said they would be available to children in England only as part of clinical research trials.

She concluded that there was a “lack of evidence” on the long-term impact of taking hormones from an early age, and said studies had been “exaggerated or misrepresented by people on all sides of the debate to support their viewpoint”.

Among the 32 recommendations made by Cass was a call for NHS gender services to move towards a more “holistic assessment” of those referred, including comprehensive mental health assessments.

“For most young people, a medical pathway will not be the best way to manage their gender-related distress,” said Cass.

“For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.”

The paediatrician warned that ideology on all sides of the debate had “directed care, rather than care being directed by normal principles of paediatrics and mental health”.

She added that medical professionals were “afraid to do the things that they would normally do in any other consultation with a young person, and that can’t be right”.

Her report also called for a “follow-through service” for 17 to 25-year-olds, who were “falling off a cliff edge” in terms of the NHS care they received upon turning 17, at which point patients enter adult services.

In response, NHS England said it had written to local health service leaders to ask them to pause offering first appointments at adult gender clinics to young people before their 18th birthday and pledged on Wednesday to bring forward a “systemic review of adult gender services”.

“We will set out a full implementation plan following careful consideration of this final report and its recommendations,” said NHS England.

Wes Streeting, Labour’s shadow health secretary, said: “Today’s report must provide a watershed moment for the NHS’s gender identity services.

“Children’s healthcare should always be led by evidence and children’s welfare, free from culture wars. Clinicians and parents alike want the best for children at this crucial developmental stage. This report provides an evidence-led framework to deliver that,” he added.