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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 said the 'toxicity' around gender issues was a serious problem. Pic: PA
Image:
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.

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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.”

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Rhianan Rudd: How mother’s boyfriend played ‘significant’ role in radicalising youngest UK girl to face terror charges

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Rhianan Rudd: How mother's boyfriend played 'significant' role in radicalising youngest UK girl to face terror charges

Rhianan Rudd, who took her own life at the age of 16, was the youngest girl in the UK to be charged with terrorist offences. 

The inquest into her death, which concluded today, revealed shocking details about her radicalisation by two American white supremacists, one of whom was her mother’s boyfriend, who the coroner said “played a material role in her radicalisation”.

Rhianan gouged a swastika into her forehead, downloaded a bomb-making manual and told her mother she planned to blow up a synagogue.

Investigated by anti-terrorism police and MI5, charges against her were later dropped, but five month later on 19 May 2022, she was found dead in her shower in a children’s home in Nottinghamshire. Hours earlier she had posted on Instagram: “I’m delving into madness.”

The evidence heard in Chesterfield Coroner’s Court from police, social services and even an MI5 operative, raised questions over the state’s part in her death – and whether, despite her obvious radicalisation, this vulnerable, autistic girl should have been treated with more care by the authorities.

Judge Alexia Durran said: “I’m not satisfied, on the balance of probabilities, Rhianan intended to take her own life. Rhianan’s death… was the result of a self-inflicted act but it is not possible to ascertain her intention.

“Rhianan was known, to family and professionals, to be vulnerable, to have autistic traits and have a history of self-harm.”

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The coroner added: “I find she was highly affected by her arrest and was concerned about being sent to prison.”

It was not known what Rhianan was told by her legal team when the charges were dropped but this may have had a “psychological impact” on her, the coroner said.

Rhianan Rudd. Pic: Family handout
Image:
Rhianan Rudd. Pic: Family handout

In an interview released at the verdict, Rhianan’s mother Emily Carter said her daughter “should never have been charged”, that she was failed by those investigating her, including MI5 and counter terrorism police, as well as being let down by mental health services and those caring for her at the home.

This was the most complex of cases, set at a time when our security services are seeing a growing number of children being arrested and charged for terrorist offences, while parents often seem oblivious to the radicalising material they are consuming online in their bedrooms.

Ms Durham’s ruling reflected this complexity, finding that while there were some failings the actions of the police and MI5 were “reasonable and proportionate”.

The coroner concluded today that she was satisfied that missed opportunities in her case were “not systemic”.

Judge Alexia Durran said: “In the circumstances I do not consider I should make a prevention of future deaths report.”

At the same she was unequivocal about the “significant” role played by two extremists in radicalising her.

It was her mother’s former boyfriend, an American she’d befriended though a US pen-pal prison scheme, who first introduced Rhianan to far-right ideology.

Dax Mallaburn had been part of a white supremacist prison gang in the US and subsequently came to the UK to live with Rhianan’s mother in September 2017, a year after she’d been to visit him in the US.

In the autumn of 2019, Rhianan alleged that he had touched her inappropriately but later withdrew the allegation and, after a social services assessment, Mr Mallaburn returned to the family home.

Ms Carter says: “In hindsight, he was a bad person but I never saw him talking Nazi stuff with her.”

Before Rhianan was arrested, Mr Mallaburn’s relationship with her mother had broken down and he returned to the US and then Mexico. However, during COVID, Rhianan appeared to contact another far-right extremist, Christopher Cook, and began an online relationship with him.

Cook, who was roughly 18 and living in Ohio, shared far-right texts with Rhianan along with a bomb-making manual, and during this time she became fixated with Adolf Hitler.

Previously unissued photo dated 21/05/25 of Emily Carter, the mother of Rhianan Rudd, who died aged 16. In the 18 months before she died, Rh
Image:
Emily Carter, the mother of Rhianan Rudd

Cook’s lawyer, Peter Scranton, says he too was radicalised online, and he came up with a plan to blow up power stations in the US, for which he was eventually arrested in August 2020, and in February 2022 he pleaded guilty to terrorism offences.

Cook, who was a misfit at school, suffering from “severe depression” according to his lawyer and was “essentially lashing out” as he tried to form a group to carry out his plan.

Mr Scranton told Sky News, “It was white nationalism, and they had this idea, and I don’t know why anyone would feel this way or how they thought it would work, that if they tore down the government and started over they could create a new United States of America that could look like the image that they would want – a white nationalist image.”

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Mr Scranton says Cook told him he didn’t radicalise Rhianan, and it was the former boyfriend, Dax Mallaburn, who’d initially got her into neo-Nazi ideology. However, the coroner found Cook was “a significant radicaliser of Rhianan” at a time when she was “isolated and unsupervised”.

Ms Carter says Rhianan was interested in German history because she was doing it at school and Cook was able to “pull her in”, to racial hatred and antisemitism. She says she didn’t know what was happening, despite having parental controls on Rhianan’s devices. She said: “I could hear her talking to people on there and I’d say who are you talking to and she’d say – just someone from school – and in fact I found out it wasn’t at all.

“When this person she was talking to disappeared, that’s when she sat down on my lap like a baby and cried. She told me this guy Chris had left her, and she was totally in love with him – then she came down and told me she had downloaded a bomb manual and I was like ‘Oh my god, what have you been doing’.”

Ms Carter decided to contact Prevent – a national program in the UK designed to stop individuals from becoming terrorists or supporting terrorism

She says: “I thought putting her in a deradicalisation programme would be a fairly easy undo ‘brain pick’, But it wasn’t until the police turned up that I thought ‘hang on a minute this is a lot deeper than I actually thought it was at first’.”

Ms Carter and her lawyers have argued that the police were heavy-handed, that there should have been a psychological assessment before she was even questioned over terrorism offences.

“There were 19 police officers to arrest a 5ft 1, 14-year-old girl who weighs seven stone. It was over the top,” says Ms Carter.

Once Rhianan was charged, the deradicalisation work under Prevent was put on hold. Ms Carter thinks this was a mistake.

She says: “Leaving her with her own thoughts throughout the entire time of going through the police interviews and everything else – the deradicalisation would have changed the way she was seeing things – I believe she would have been able to handle it all so much better.”

The coroner described the police arrest and interview as “necessary and conducted appropriately” and that, while ceasing the Prevent intervention was an “unfortunate consequence” of the police investigation, it was “an appropriate step”.

During police interviews, Rhianan described being coerced and groomed, including sexually, and having sent explicit images of herself to Cook.

Lawyers representing the family say police and MI5 knew she was the victim of child sexual exploitation but failed to refer her to the relevant body – the National Referral Mechanism.

It was only after a social worker made the referral, that she was identified as a child victim and then the charges were dropped, by which time she had been subject to investigation and prosecution for 15 months.

The coroner agreed that there was a “systems failure” due to a lack of training both within the police and the Derbyshire council who both had had “significant information” that she was a potential victim of modern slavery.

However, she also said it “was impossible to know” whether this would have led to the CPS dropping their charges sooner, “nor that if had more than minimal impact on Rhianan’s death”.

Ms Carter says if she’d been treated differently “she’d be troubled, but I do think she’d still be alive”.

Rhianan’s family say the security services knew her vulnerabilities and that she had a tendency to self-harm, but they failed to take this into account.

Ms Carter said: “I admit my mistakes and I want the organisations to admit their mistakes. There were failings and they need to admit them.”

This ruling however found that the state did not play a role in Rhianan’s death under article 2 of the European Convention on Human Rights.

For the most part, her vulnerabilities were known and taken into consideration. It does however show how extremists will exploit children with mental health problems, young people who are struggling with life who may be a danger to society, but also a risk to themselves.

Counter Terrorism Policing said it offered “sincere condolences to Rhianan’s family and loved ones for their terrible loss”.

Assistant Chief Constable Di Coulson, speaking on behalf of Counter Terrorism Policing in the East Midlands (CTPEM) and Derbyshire Constabulary, said: “This was a complex case involving a very vulnerable young person, who had been subjected to radicalisation.

“Rhianan’s tragic death was clearly devastating for her family. It was felt profoundly by the officers directly involved, but also across Counter Terrorism Policing as a whole.

“Rhianan’s case was a stark moment for our management of the growing numbers of children and young people in our casework – so often presenting vulnerability as well as risk and threat to the public.

“Since Rhianan’s death, we continue to work alongside our partners to evolve the way we approach cases involving children and, where feasible, attempt to rehabilitate and deradicalise, rather than investigate and convict.

“We welcome the findings of the Chief Coroner today, and while we have already made substantial improvements to the way we manage these cases, we will carefully review the findings and make any further changes in order to improve our protection of the public against terrorism.”

Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK

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The five considerable problems with the chancellor’s U-turn on winter fuel payments

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The five considerable problems with the chancellor's U-turn on winter fuel payments

There are considerable problems with the winter fuel payment U-turn, but perhaps the political argument in favour outweighs them all?

First, Rachel Reeves has executed the plan without working out how to pay for it.

This, for an iron chancellor, is a wound that opponents won’t let her forget. A summer of speculation about tax rises is not a summer anyone looks forward to.

Politics latest: Treasury minister challenged over reason for U-turn

Second, the fig leaf that she and Treasury ministers are using is an improvement in economic conditions.

If you were being polite, you’d say this is contested.

The OBR halved growth this year and the OECD downgraded UK forecasts, albeit only by a little, last week.

More on Rachel Reeves

The claim that interest rates are coming down ignores that their descent is slower because of government decisions of the last six months.

Third, the question immediately becomes, what next?

Why not personal independent payments (PIP) and the two-child benefit cap?

At this stage, it would feel like a climbdown if they did not back down over those.

But then, what will the markets – already policing this closely – make of it, and could they punish the government?

Fourth, this is aggravating divisions in the Parliamentary Labour Party: the soft left Compass group and ministers like Torsten Bell pushing bigger spending arguments.

Those MPs in Tory-facing seats who rely on arguments that Labour can be trusted with the public finances are worried.

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Fifth, this has created a firm division between No 10 (the PM) and No 11 (the Chancellor).

No 10 is now conscious that it does not have enough independent advice about the market reaction to economic policies and is seeking to correct.

Others, I am told, are just critical of the chancellor’s U-turn – for she wobbled first.

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How much cash will Reeves give each department?

Given the litany of arguments against, why has it happened?

Because the hope is this maxi U-turn lances the boil, removes a significant source of pensioners’ anger and brings back Labour voters, a price they calculate worth paying, whatever the fiscal cost.

We wait to see who is right.

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NHS trust and ward manager found not guilty of manslaughter after woman took her own life at hospital

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NHS trust and ward manager found not guilty of manslaughter after woman took her own life at hospital

Warning: This article contains references to suicide

An NHS trust on trial following the death of a young woman at an east London hospital has been cleared of corporate manslaughter.

Alice Figueiredo, 22, took her own life while being treated at Goodmayes Hospital in July 2015.

The North East London NHS Foundation Trust (NELFT) had been charged with corporate manslaughter and was found not guilty, following a months-long trial. But it was instead found guilty of failing to ensure the health and safety of non-employees.

A not guilty verdict was also returned for hospital ward manager Benjamin Aninakwa, who was charged with gross negligence manslaughter.

Aninakwa also denied a charge of failing to take reasonable care for the health and safety of patients on the ward. He was found guilty.

The decisions were made after the joint-longest jury deliberation in English legal history.

A spokesperson for the North East London NHS Foundation Trust said their thoughts were with Alice’s family and loved ones.

“We extend our deepest sympathy for the pain and heartbreak they have suffered this past ten years,” they said.

“We will reflect on the verdict and its implications, both for the Trust and mental health provision more broadly as we continue to work to develop services for the communities we serve.”

Aninakwa was accused of failing to remove items from the ward capable of use for self-harm and failing to ensure incidents of self-harm were recorded, considered and addressed.

Alice Figueiredo story

Ms Figueiredo was described as a bright and gifted young woman, who had been head girl at her school.

She struggled with her mental health and had been diagnosed with an eating disorder as well as bipolar affective disorder.

In February 2015, Ms Figueiredo was admitted to Hepworth Ward, an acute psychiatric unit at Goodmayes Hospital.

During her five months on the ward, the jury at the Old Bailey heard how she had attempted to harm or kill herself on 39 occasions, including 18 times with plastic bags.

Despite this, Ms Figueiredo was able to access a bag, and on 7 July she killed herself using a bag taken from a communal toilet on the ward.

Alice Figueiredo was admitted to Goodmayes hospital
Image:
Alice Figueiredo was admitted to Goodmayes Hospital

The trial also heard evidence about the reporting of incidents on the hospital computer system.

Last year, Health Secretary Wes Streeting made damning remarks about NELFT at a conference of NHS leaders.

“I’m very aware of NELFT not least because NELFT has and continues to appear in the headlines for providing really poor quality care,” he said.

Ms Figueiredo’s family visited her regularly in hospital, and repeatedly raised concerns about her care.

The jury heard how her mother, Jane Figueiredo, wrote to managers warning: “It is only a matter of time before there is a fatality on this ward.”

Campaigners believe Ms Figueiredo’s death points to wider problems with mental health care.

Deborah Coles, director of the charity Inquest, said: “I hope that irrespective of the verdict, this will send shock waves and ensure that learning and change is an absolute priority.”

Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK

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