Gender identity services for young people in Scotland should focus on a “holistic” approach with youngsters at its heart, a report on the implications of the Cass Review has said.
The review by Dr Hilary Cass examined gender care services in England and criticised the lack of evidence around the use of puberty blockers and other medical intervention.
A multi-disciplinary team established to consider how the recommendations in the Cass Review might apply to NHS services in Scotland has now submitted its findings to the Scottish Parliament.
Its report, overseen by Scotland’s Chief Medical Officer Sir Gregor Smith, considered all 32 recommendations of the Cass Review and assessed to what extent they are applicable north of the border and whether they can be implemented in the health service.
Its recommendations include that a lead senior clinician, preferably a consultant, should take overall responsibility for each young person’s care and that each care plan should include a full assessment of the child’s needs, both psychological and physical.
The review also recommends that, as elsewhere in the UK, the use of puberty-suppressing 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.
Scotland’s 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.”
Following the publication of the Cass Review in April, two Scottish health boards – one of which covers the only gender clinic in the country for young people – decided to pause the prescription of puberty blockers to new patients.
The report led by Sir Gregor recommends that 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.
Pre-election rules prevented publication in the run-up to the General Election, but a commitment was made to the Scottish Parliament to publish at the first opportunity after the restricted period ended.
The conclusions of the report will now be considered by the Scottish Government.
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.”