The British Medical Association (BMA) has dropped its opposition to the findings of the Cass review of gender identity services across the NHS, marking a significant shift in the doctors' union's position.
Background of the Cass Review
The Cass review, published in April 2024 and led by Dr. Hilary Cass, concluded that children and young people had been failed by a lack of research and evidence on medical interventions, stating that NHS gender medicine was "built on shaky foundations." The review made 32 recommendations for improving care.
BMA's Initial Rejection
Initially, the BMA's council voted to oppose the implementation of the review, labeling its findings as "unsubstantiated." However, on Wednesday, the union released its own long-awaited review of Cass's findings, conducted by 12 members.
Prof. David Strain, chair of the BMA's board of science and leader of the internal review, said the Cass report's methodology was robust. "A strength of this work has been the ability of clinicians with differing perspectives to engage constructively to ensure the concerns of the profession and those with lived experience were explored," he stated. He added that while interpretations and policy preferences diverged, there was consistent respect for the underlying data and ethical complexity.
Key Findings and Government Actions
Despite endorsing the Cass review, the BMA criticized some government actions taken after its publication, such as banning puberty blockers on the NHS. The union argued this move went beyond Cass's recommendations and threatened doctors' autonomy. "We spend decades training on how to use drugs, and to have a political decision affecting the way we prescribe is wrong," the BMA said.
The Cass review, which took four years and analyzed data from 113,000 children, found no evidence supporting the prescription of sex hormones to under-18s. It also highlighted that young people often present with complex needs like trauma, self-harm, and depression, which were sometimes not adequately explored before medical treatment pathways were considered.
Impact of the Cass Review
As a result of the review, the Tavistock clinic in London, the UK's only NHS gender identity development service, was permanently closed in March 2024. The clinic had treated approximately 9,000 children and young people, with an average referral age of 14, between 2009 and 2020.
NHS England has been approached for comment but has not yet responded.
