PM urges ‘extreme caution’ on gender treatments as NHS plans major review of clinics
The prime minister has said there should be “extreme caution” about gender treatments as a new report said children are being failed by gender services.
NHS England said it would now pause first appointments at adult clinics for teenagers under 18, and intends to carry out a major review of its adult gender services and use of hormones.
The report by Dr Hilary Cass found that there is “remarkably weak evidence” to support gender treatments for children.
The “toxicity of the debate” is also not helping, with people afraid of discussing transgender issues openly, she said.
The paediatrician criticised the current system in her report on gender identity services for children and young people.
Dr Cass makes 32 recommendations, including that gender services operate “to the same standards” as other children’s health services.
She recommends “extreme caution” and “a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18”.
The current policy on giving children testosterone or oestrogen from age 16 should also be urgently reviewed, according to Dr Cass.
Addressing young people, she writes: “I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age; research has let us all down, most importantly you.”
She said it was also important to ensure parents “are not unconsciously influencing the child’s gender expression”.
Dr Cass also recommends “a holistic assessment” including a mental health assessment and screening for conditions such as autism.
Dr Cass says the ‘toxicity’ around gender issues is a serious problem. Pic: PA
‘We have no good long-term evidence’
A review of 50 studies on puberty blockers and 53 on hormone treatments – carried out for the report – found a “lack of high-quality research” into their use in young people.
“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” said Dr Cass.
The publication comes weeks after NHS England confirmed children would no longer be prescribed puberty blockers outside of research trials.
It’s also less than a fortnight since the much-scrutinised Gender Identity Development Service (GIDS) closed in London – with two new hubs to replace it.
The review was commissioned by NHS England four years ago after a steep rise in the numbers seeking help for gender issues.
The controversial Gender Identity Development Service (GIDS) closed last month. Pic: PA
There was particular concern over early medical interventions despite a lack of evidence on their use and long-term impacts.
Prime Minister Rishi Sunak welcomed the review, saying: “It aligns with our approach on this issue”.
“Of course we must treat children who are questioning their gender with compassion and sensitivity, but we have to recognise that we need to move with extreme caution in these areas, because we just simply don’t know the long-term impacts of what this all means,” he said.
Laura Farris, the victims and safeguarding minister, told Sky News there would be a “fundamental change of direction” as a result of the review’s findings and that work had started after an interim version of the report.
She said: “We are going to have regional support centres across the UK so that a child who is questioning their gender will be given a holistic package of support – and not just funnelled down an irreversible pathway where they may find that they reach adulthood and then wonder how on earth they were ever allowed to take those steps.”
Concerns report is ‘open to misinterpretation’
Mermaids, a charity that supports transgender young people, said the report “recognises the current system is failing trans youth”.
The charity criticised “appalling waiting lists of more than six years, virtually no first appointments offered for over a year, and increased politicisation of the support offered to children and young people”.
It added: “Trans youth tell us they want services which are accepting and respectful, which offer supportive spaces to explore their gender, and provide access to medical transition if and when they need it.
“We are pleased the voices and experiences of trans young people appear to have been heard and respected, and we welcome Dr Cass’ calls for trans children and young people, and their families, to be ‘treated with compassion and respect’.”
But Mermaids added it also had concerns some of the language in the report is “open to misinterpretation” and “could be used to justify additional barriers to accessing care for some trans young people in the same way the interim report has been”.
“We call on NHS England, and the NHS across the UK, to resist pressures from those who seek to limit access to healthcare, listen to trans youth directly, and act urgently to provide gender services which are timely, supportive and holistic,” the charity added.
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‘Wrong’ services have ‘terribly let down’ children
Dr David Bell, a psychiatrist who authored a critical report about gender services in 2018, told Sky News that Dr Cass’ review makes clear that the affirmation model – accepting when a child expresses that they are transgender – “has been completely the wrong clinical stance”.
“The right clinical stance is neutrality, exploration, understanding all the other multiple problems these children have that are being expressed through distress about their gender,” he said.
“These children have many complex problems and have been terribly let down, first of all by being put on a medical pathway which was inappropriate and which there has been considerable concern about the damage done to children by puberty blockers.
“But also that the other problems that they had were not properly addressed… by clinical services that act in such a way following the ordinary canons of clinical care.
“Instead what’s happened, they were totally captured by trans ideology so it became an ideological issue rather than a clinical issue and it is that that’s caused the damage.”
‘Falling off a cliff edge’
Other recommendations include a “follow-through service” for 17-25-year-olds, with Dr Cass warning teenagers are “falling off a cliff edge” when it comes to care.
She also urged a “more cautious approach” for children than for adolescents when it comes to social transitioning – where someone might change their pronouns, name, and clothing.
The paediatrician said her review was “not about defining what it means to be trans, nor is it about undermining the validity of trans identities”.
However, she cautioned that strong feelings on trans issues were having a damaging effect.
She said experienced clinicians had at times been “dismissed and invalidated” and that young people had been “caught in the middle of a stormy social discourse”.
“There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop,” she wrote.
She warned that “polarisation and stifling of debate” would also hamper essential research in an area with “remarkably weak evidence”.
In response, NHS England said it had made “significant progress” towards establishing a “fundamentally different gender service for children and young people” based on Dr Cass’s earlier recommendations, as well as “extensive public consultation and engagement”.
A spokesperson said: “We will set out a full implementation plan following careful consideration of this final report and its recommendations, and the NHS is also bringing forward its systemic review of adult gender services and has written to local NHS leaders to ask them to pause offering first appointments at adult gender clinics to young people below their 18th birthday.”
UK
Zhenhao Zou: More than 20 new potential victims come forward after ‘prolific’ rapist jailed for assaulting 10 women
Another 23 female potential victims have reported that they may have been raped by Zhenhao Zou – the Chinese PhD student detectives believe may be one of the country’s most prolific sex offenders.
The Metropolitan Police launched an international appeal after Zou, 28, was convicted of drugging and raping 10 women following a trial at the Inner London Crown Court last month.
Detectives have not confirmed whether the 23 people who have come forward add to their estimates that more than 50 other women worldwide may have been targeted by the University College London student.
Metropolitan Police commander Kevin Southworth said: “We have victims reaching out to us from different parts of the globe.
“At the moment, the primary places where we believe offending may have occurred at this time appears to be both in England, here in London, and over in China.”
Metropolitan Police commander Kevin Southworth
Zou lived in a student flat in Woburn Place, near Russell Square in central London, and later in a flat in the Uncle building in Churchyard Row in Elephant and Castle, south London.
Read more: How a student described as ‘smart and charming’ was unmasked as a prolific sexual predator
He had also been a student at Queen’s University Belfast, where he studied mechanical engineering from 2017 until 2019. Police say they have not had any reports from Belfast but added they were “open-minded about that”.
“Given how active and prolific Zou appears to have been with his awful offending, there is every prospect that he could have offended anywhere in the world,” Mr Southworth said.
“We wouldn’t want anyone to write off the fact they may have been a victim of his behaviour simply by virtue of the fact that you are from a certain place.
“The bottom line is, if you think you may have been affected by Zhenhao Zou or someone you know may have been, please don’t hold back. Please make contact with us.”
Pic: Met Police
Zou used hidden or handheld cameras to record his attacks, and kept the footage and often the women’s belongings as souvenirs.
He targeted young, Chinese women, inviting them to his flat for drinks or to study, before drugging and assaulting them.
Zou was convicted of 11 counts of rape, with two of the offences relating to one victim, as well as three counts of voyeurism, 10 counts of possession of an extreme pornographic image, one count of false imprisonment and three counts of possession of a controlled drug with intent to commit a sexual offence, namely butanediol.
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Moment police arrest rapist student
Mr Southworth said: “Of those 10 victims, several were not identified so as we could be sure exactly where in the world they were, but their cases, nevertheless, were sufficient to see convictions at court.
“There were also, at the time, 50 videos that were identified of further potential female victims of Zhenhao Zou’s awful crimes.
“We are still working to identify all of those women in those videos.
“We have now, thankfully, had 23 victim survivors come forward through the appeal that we’ve conducted, some of whom may be identical with some of the females that we saw in those videos, some of whom may even turn out to be from the original indicted cases.”
Mr Southworth added: “Ultimately, now it’s the investigation team’s job to professionally pick our way through those individual pieces of evidence, those individual victims’ stories, to see if we can identify who may have been a victim, when and where, so then we can bring Zou to justice for the full extent of his crimes.”
Mr Southworth said more resources will be put into the investigation, and that detectives are looking to understand “what may have happened without wishing to revisit the trauma, but in a way that enables [the potential victims] to give evidence in the best possible way.”
The Metropolitan Police is appealing to anyone who thinks they may have been targeted by Zou to contact the force either by emailing survivors@met.police.uk, or via the major incident public portal on the force’s website.
An 11-year-old girl who went missing after entering the River Thames has been named as Kaliyah Coa.
An “extensive search” has been carried out after the incident in east London at around 1.30pm on Monday.
Police said the child had been playing during a school inset day and entered the water near Barge House Causeway, North Woolwich.
A recovery mission is now said to be under way to find Kaliyah along the Thames, with the Metropolitan Police carrying out an extensive examination of the area.
Barge House Causeway is a concrete slope in North Woolwich leading into the Thames
Chief Superintendent Dan Card thanked members of the public and emergency teams who responded to “carry out a large-scale search during a highly pressurised and distressing time”.
He also confirmed drone technology and boats were being used to “conduct a thorough search over a wide area”.
He added: “Our specialist officers are supporting Kaliyah’s family through this deeply upsetting time and our thoughts go out to all those impacted by what has happened.”
“Equally we appreciate this has affected the wider community who have been extremely supportive. You will see extra officers in the area during the coming days.”
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On Monday, Kerry Benadjaoud, a 62-year-old resident from the area, said she heard of the incident from her next-door neighbour, who “was outside doing her garden and there was two little kids running, and they said ‘my friend’s in the water'”.
When she arrived at the scene with a life ring, a man told her he had called the police, “but he said at the time he could see her hands going down”.
Barge House Causeway is a concrete slope that goes directly into the River Thames and is used to transport boats.
Residents pointed out that it appeared to be covered in moss and was slippery.
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