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Mermaids Press

The Cass Review’s Interim Report, published 10 March 2022, clearly recognises that NHS England’s current healthcare model is not fit for purpose and that trans children and young people deserve, but are not currently receiving, the same standard of care as everybody else. 

Any healthcare pathway has to be informed by those it is there to help, here being trans, non-binary, gender diverse and/or gender exploring children and young people. We read the report from this perspective and in doing so we see these interim recommendations as a positive step toward much-needed change.

We do recognise however, that this is an interim report – those claiming this as a “win” or “lose” moment, do so prematurely. We are committed to continue working with the review team to ensure the voices of young trans people are at the centre of this work.

We are pleased to see recommendations that echo some of the calls our community has been making, including to: 

1. Establish regional centres for direct service delivery, thereby creating more services closer to where we live; 

2. Significantly increase training for healthcare professionals at all levels and addressing long-term workforce issues, thereby addressing capacity issues;

3. Creating consistency in a clinical approach which is open, respects the experiences of the young person, and prioritises the consent of the young person, thereby avoiding a “postcode lottery” of care;  

4. Improve data collection to help inform the pathway’s future development. 

At Mermaids, we know all too well how inadequate the healthcare system is for trans and gender-diverse young people. We are pleased to see that the Cass Review doesn’t shy away from emphasising the need for a system-wide response to reduce current waiting times of over three years, that the Review emphasises that puberty blockers are not experimental, as well as acknowledging that “doing nothing cannot be considered a neutral act” (p. 63).

It is worth addressing confusion on what is meant by affirmative care. Mermaids supports both national (British Psychological Society) and international (WPATH) guidance and best practice on the use of an affirmative approach to trans healthcare, which simply means supporting a young person’s understanding of who they are while taking an exploratory approach. The two are not mutually exclusive. In our view, this aligns with the interim report’s approach of supportive, exploratory intervention. We welcome clarification from the Cass Review team on this.

What now?

The Interim Report is an important first step towards a complete overhaul of the current gender identity healthcare model. We know that there is much more to be done and transformation cannot happen overnight. We want to reassure trans, non-binary and gender diverse young people and their families that we are working hard to ensure your voices and experiences are heard throughout the process. We will continue to work with the Cass Review team and are hopeful the final recommendations will bring about the meaningful change that is so drastically overdue.