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.”
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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.
‘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 review was commissioned by NHS England four years agoafter a steep rise in the numbers seeking help for gender issues.
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.
‘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.”
Tulip Siddiq has resigned as a Treasury minister after controversy over links to her aunt’s ousted political movement in Bangladesh.
In a letter to Sir Keir Starmer, the Hampstead and Highgate MP said while she had “not breached the ministerial code”, continuing in her post would be “a distraction from the work of the government”.
She previouslyinsisted she had “done nothing wrong” but referred herself to the prime minister’s ethics watchdog, Sir Laurie Magnus, last week.
In a letter to Sir Keir, the independent adviser called it “regrettable” Ms Siddiq “was not more alert to the potential reputational risks” arising from her close family’s association with Bangladesh.
He said this “shortcoming” should not be taken as a breach of the ministerial code, “but you will want to consider her ongoing responsibilities in the light of this”.
Sir Laurie reviewed Ms Siddiq’s financial affairs and the background of properties she owns or has occupied and said he found no evidence of any “improprieties” in her actions.
In his reply, Sir Keir said he has accepted Ms Siddiq’s resignation “with sadness”, adding: “I also wish to be clear that Sir Laurie Magnus as Independent Adviser has assured me he found no breach of the ministerial code and no evidence of financial improprieties on your part.”
He praised her for making the “difficult decision” to resign nonetheless and said “the door remains open for you” going forward.
Downing Street has announced Wycombe MP Emma Reynolds has been appointed to replace her in the Treasury, and Torsten Bell will take Ms Reynolds’ previous role in the Department for Work and Pensions.
Ms Siddiq had the role of city minister, which meant she was responsible for illicit finance and corruption.
The UK Anti-Corruption Coalition had called for Ms Siddiq to resign earlier this week, accusing her of a “serious conflict of interests” regardless of whether Sir Laurie found she had breached the ministerial code.
In a post on X, Tory leader Kemi Badenoch accused Sir Keir of “dither and delay to protect his close friend”, saying it became clear over the weekend Ms Siddiq’s position “was completely untenable”.
Sarah Olney, the Liberal Democrat’s Cabinet Office spokesperson, said: “After years of Conservative sleaze and scandal, people rightly expected better from this government.”
What are the allegations facing Ms Siddiq?
It is alleged that Ms Siddiq lived in properties in London linked to allies of Ms Hasina, who is facing an investigation by an anti-corruption commission in Bangladesh.
This includes a £2.1m house in Finchley which the MP rents and which is owned by businessman Abdul Karim Nazim, an executive member of her aunt’s Awami League party’s UK branch.
In referring herself to Sir Laurie for investigation, Ms Siddiq said much of the reporting surrounding her financial affairs and links to Bangladesh had been inaccurate and “I am clear that I have done nothing wrong”.
Ms Siddiq has also been named in Bangladesh court documents as allegedly helping her aunt broker a 2013 deal with Russia for the Rooppur nuclear power plant, which she denies.
Bangladesh’s anti-corruption commission has also alleged she was involved in the illegal allocation of plots of land in the diplomatic zone of a development near Dhaka to her mother, sister and brother.
A Labour source said she totally refutes the claims and had not been contacted by anyone on the matter.
Ms Siddiq had been due to join a delegation heading to China last week, but stayed in the UK to fight to clear her name.
But further pressure mounted after Sky News discovered historical blog posts she wrote describing campaigning with her aunt in Bangladesh’s general election and celebrating her victory.
Ms Siddiq had previously said she and her aunt never spoke about politics.
The Times also reported the MP’s Labour Party flyers and a thank you note to local Labour Party members after she was elected as an MP were found in the palace in Dhaka that belonged to her aunt.
Comedian and actor Tony Slattery has died aged 65 following a heart attack, his partner has said.
The actor was famous for appearing on the Channel 4 comedy improvisation show Whose Line Is It Anyway? and other series such as Just A Minute and Have I Got News For You.
He had recently been touring a comedy show and launched his podcast, Tony Slattery’s Rambling Club, just a few months ago, in October.
A statement made on behalf of his partner, Mark Michael Hutchinson, said: “It is with great sadness we must announce actor and comedian Tony Slattery, aged 65, has passed away today, Tuesday morning, following a heart attack on Sunday evening.”
Born in 1959, Slattery went to the University of Cambridge alongside contemporaries Dame Emma Thompson, Sir Stephen Fry and Hugh Laurie.
While there, he served as president of the legendary Cambridge Footlights improvisation group.
Alongside Sir Stephen and Dame Emma, he was the winner of the first Perrier Award at the Edinburgh Fringe. He was also one of the original patrons of Leicester Comedy Festival, along with Norman Wisdom and Sean Hughes, and had been a rector at the University of Dundee.
Slattery spoke regularly about his bipolar disorder and in 2020 revealed that he went bankrupt following a battle with substance abuse and mental health issues.
He told the Radio Times that his “fiscal illiteracy and general innumeracy” as well as his “misplaced trust in people” had also contributed to his money problems.
He released a BBC documentary called What’s The Matter With Tony Slattery? in the same year, which saw him and Hutchinson visit leading experts on mood disorders and addiction.
Comedians pay tribute to ‘dazzling talent’
Comedians including Richard K Herring and Al Murray are among those who have paid tribute.
“Really sad news about Tony Slattery,” Murray wrote on X. “Such a dazzling talent.”
Tom Walker, best known as the satirical journalist personality Jonathan Pie, said news of Slattery’s death was “absolutely heartbreaking”, and described the comedian as a “genius”.
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As well as comedy improvisation shows, Slattery appeared in films in the 1980s and 1990s, including crime thriller The Crying Game, black comedy How To Get Ahead In Advertising, alongside Richard E Grant, and Peter’s Friends, which also starred Laurie, Sir Stephen and Dame Emma.
His film and TV credits also included Carry On Columbus, Robin Hood, Red Dwarf, The English Harem, Cold Blood, The Royal, Just A Gigolo, Tiger Bastable and Coronation Street.
On stage, he received an Olivier Award nomination for best comedy performance in 1995, for the Tim Firth play Neville’s Island, which was later made into a film starring Timothy Spall. He also starred in Privates On Parade, based on the film of the same name, as impersonator Captain Terri Dennis, and made his West End debut in the 1930s-style musical Radio Times.
Slattery is survived by Hutchinson, an actor, and his partner of more than three decades.
Anti-corruption minister Tulip Siddiq has resigned after controversy over links to her aunt’s ousted political movement in Bangladesh.
The Hampstead and Highgate MP is probably best known for campaigning for the release of her constituent, Nazanin Zaghari-Ratcliffe, who was detained in Iran for six years.
The mother-of-two also hit the headlines in 2019 when she delayed having a C-section so she could vote against Boris Johnson’s Brexit deal, turning up to parliament heavily pregnant and in a wheelchair.
Ms Siddiq was first elected to parliament in 2015, in what was then the most marginal seat in the country, and before that served as a local councillor in Camden.
In blog posts written in late 2008 and early 2009, when she was a Labour activist, Ms Siddiq described campaigning with her aunt in the south Asian country’s general election and celebrating her victory.
Ms Siddiq’s maternal grandfather was Sheikh Mujibur Rahman, Bangladesh’s first president, who was assassinated along with most of his family in a military coup in 1975.
Her mother and aunt survived because they were abroad at the time – her mother going on to claim political asylum in the UK, where the Labour MP was born.
Ms Siddiq lived in south London until she was five then spent 10 years living in different parts of Asia, including India and Bangladesh.
She returned to the UK capital as a teenager, where she has lived ever since.
Ms Siddiq has previously described having an “unusual childhood”, when she met the likes of Bill Clinton and Nelson Mandela.
She said she joined the Labour Party because of the NHS, but living in places like Bangladesh made it “hard not to be political because politics plays an everyday part in your life”.
However, it is her links to the country’s political dynasty that have brought her down.
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Ms Siddiq has been under pressure since December, when she was named in court documents which detailed claims her family embezzled billions of pounds from a nuclear power project in Bangladesh.
She is alleged to have helped coordinate meetings with the Russian government regarding the Rooppur nuclear infrastructure scheme in 2013.
She has also come under scrutiny over reports she lived in properties in London linked to allies of her aunt.
The Conservatives had called for Ms Siddiq to be sacked, while Bangladeshi leader Muhammad Yunus said London properties used by the MP should be investigated and handed back to his government if they were acquired through “plain robbery”.
What are the allegations against Ms Siddiq?
The allegations centre on financial links between Tulip Siddiq and political allies of her aunt – the former prime minister of Bangladesh Sheikh Hasina.
Ms Siddiq currently rents a £2m house in north London owned by a businessman with reported links to Ms Hasina’s Awami League party.
She also owns a flat in central London that the Financial Times reports was gifted to her by an ally of her aunt.
And she was registered at another London property that was transferred to her sister in 2009 by a lawyer who has represented Ms Hasina’s government.
At the time, Sir Keir Starmer said she had “acted entirely properly” in referring herself to Sir Laurie Magnus, the independent ethics adviser, and said he had “full confidence” in her.
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She was appointed the economic secretary to the Treasury after Labour’s election victory in July.
As the city minister – or anti-corruption minister as the role is often called – she held responsibility for financial crime and illicit finance.
Before the general election, she held shadow positions for the Treasury and education departments under Sir Keir Starmer.
She was also part of Jeremy Corbyn’s shadow cabinet between 2016-17 but resigned over his order not to “block” the bill to trigger Article 50 and start Britain’s exit from the EU.