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
Brixham: Warning ‘heads are going to roll’ after water parasite outbreak – as ‘nearly every house in one close has someone ill’
Thousands of homes have had their boiling water restrictions lifted after a water tank infected with cryptosporidium was drained and cleaned, South West Water has said.
About 16,000 households in the Brixham area of Devon were told to boil their drinking water following 46 confirmed cases of the disease.
On Saturday afternoon South West Water lifted the boiling restrictions for 14,500 homes after water quality monitoring results found no traces of cryptosporidium in the Alston supply area.
Cryptosporidiosis is caused by a tiny parasite and can lead to vomiting, stomach cramps and watery diarrhoea lasting about two weeks.
More cases are expected to be confirmed due to a delay in developing symptoms – and about 100 more people around Brixham were reporting signs of it on Friday.
South West Water believes the parasite probably entered supplies through a damaged pipe in a field containing animal faeces.
A contaminated water tank at Hillhead reservoir, where cryptosporidium was detected, was drained overnight and “thoroughly cleaned” on Saturday, South West Water said.
One local resident said she knew of only four houses out of 21 in Raddicombe Close, on the outskirts of Brixham, which have not had at least one person fall ill with cryptosporidiosis.
The local MP has warned “heads are going to roll” over the incident.
Tory MP Anthony Mangnall, whose constituency includes Brixham, told LBC: “This is such a serious matter that yes, I think heads are going to roll over this.”
He claimed the supplier had been too slow to issue its safety alert.
16,000 businesses and residents are affected by the boil water notice. Pic: South West Water
Mr Mangnall said: “From starting this week with a denial from South West Water that it was anything to do with them, delaying the fact that the boil water notice came in – meaning thousands of people used the water network – to then issuing it on Wednesday, and there are a lot of people who are very ill.”
He called it an “absolutely disastrous week” and said locals were furious.
South West Water has said it’s “deeply sorry” and that it’s been “working tirelessly” to identify the source of the problem and fix it.
Bottled water stations have been set up in the area.
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Liberal Democrat leader Sir Ed Davey accused the government of not doing enough to hold water companies to account.
He told Sky News the firms were “putting profit over the environment, over public health” after multiple cases of sewage being released into rivers and seas.
“We [Liberal Democrats] wouldn’t wait for fines for pollution,” Sir Ed said.
“There should be a sewage tax on the profits of these water companies so we can get the money now.
“There needs to be much tougher regulation… and we may need to look at restructuring the whole water industry.”
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Kelly Holmes joins anti-sewage protest
It comes as dozens of protests over sewage releases were planned for Saturday.
Surfers Against Sewage is promoting “paddle-out” demonstrations at 30 locations, with Olympian Dame Kelly Holmes among those at the event in Brighton.
The confirmed cases of a waterborne disease caused by a parasite have more than doubled.
There are now 46 confirmed cases of cryptosporidiosis, a diarrhoeal illness, the UK Health Security Agency (UKHSA) has said – with more than 100 further people reporting similar symptoms in the Brixham area.
Other reported cases of diarrhoea and vomiting in residents and visitors to the south Devon town are also under investigation. Hundreds of locals have also reported feeling unwell over the last two weeks on social media.
MPs and South West Water officials have confirmed the parasite most likely entered water supplies through animal faeces, but an investigation is still ongoing.
What is cryptosporidiosis disease?
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‘Cow faeces’ infected Devon water
The UKHSA first confirmed cases of the disease at around midday on Wednesday, while locals were initially told by South West Water that their tap water was uncontaminated and safe to drink.
But after testing supplies in the Hillhead reservoir, the water company found “small traces” of the parasite cryptosporidium – which causes cryptosporidiosis – and told residents in parts of Brixham and Alston to boil their drinking water on Wednesday.
A total of 16,000 households and businesses in Brixham, Boohay, Kingswear, Roseland and North West Paignton were impacted and offered £15 compensation at first.
Over the next two days, South West Water apologised to those affected and increased the offer to £115. Amid the chaos, one primary school closed its doors on Thursday due to not having safe running drinking water.
16,000 businesses and residents are affected by the boil water notice. Pic: South West Water
‘Very hard questions for water company’
Speaking to Sky News yesterday, South West Water’s chief customer officer Laura Flowerdew confirmed it was likely a broken air valve contaminated by animal faeces that had caused the outbreak.
However, she refused to give a timeframe on how long the incident would be ongoing – leaving thousands of residents facing an uncertain future.
Speaking on Friday at the University of Exeter, Health Secretary Victoria Atkins said there will be “very, very hard questions” for South West Water over the outbreak.
“At the moment I think we probably need to give them the space to conduct their investigation; we know that they have identified the source,” she said.
“The public will want to know how on earth that source happened, what was the chain of events that led to this, because of course we all understand the expectation that we all have when we turn our taps on is that [we get] clean drinking water and we want to be able to trust it.”
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Most cases of cryptosporidiosis pass in two weeks. Symptoms include diarrhoea and vomiting. File pic: Dr_Microbe/iStock
‘Expect to see more cases’
Totnes MP Anthony Mangnall also warned the boil notice could last “at least a further six or seven days” and called for more transparency.
Professor Paul Hunter, a specialist in medical microbiology at the University of East Anglia, told Sky News if the parasite was “a continuous thing” present in water supplies for a prolonged period, then “you’d expect to see more cases” for another two weeks.
It comes as hotel owners in the area told Sky News the outbreak has led to people cancelling their stay, while a head chef said “I can’t wash salad in the sink”.
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‘Destroyed our business’
Stephen Colemansfield, owner of Redlands Guest House in Brixham, told Sky News the outbreak has “destroyed our business at the moment”.
“Our guests have cancelled because of the mixed messages that are being sent out by South West Water.”
Rob, head chef at the Steam Packet Inn in Kingswear near Dartmouth, also said his brother-in-law is one of the 46 confirmed cases of cryptosporidiosis and has been sick for two weeks.
The UKHSA is working with Torbay Council, South West Water, NHS Devon and the Environment Agency on the incident.
Colin Smith carries a small suitcase into the dining room of their Newport home and lays it flat on the table in the centre of the room. He pops open both latches.
His wife Jan reaches inside and pulls out a sky blue child’s blanket. She holds it close to her face, closes her eyes and inhales deeply.
“It still smells of him,” she says, softly.
“This is the blanket he was wrapped in when he died.”
Their son, also called Colin, was just seven years old when he died in January 1990. His tiny body was ravaged by Hepatitis C and AIDS.
The suitcase, much like the one most families used to own in the 1980s, is just big enough to hold all the memories of their son’s short life.
Next to the blanket, are his favourite toys including a snow globe and lots of his artwork.
Jan and Colin Smith look through the suitcase containing their son’s possessions
Jan explains that Collin, loved to paint and draw and that he was very talented.
“He was 13 pounds when he died. That’s nothing is it for a seven-year-old?” Jan asks.
The question goes unanswered as a momentary silence fills the room.
Colin was born with haemophilia. The treatment for his blood clotting disorder included a product called Factor VIII.
What his parents didn’t know was that the Factor VIII was made in America using blood farmed from prisoners, drug addicts and sex workers.
Jan can recall all the fine details of that day clearly. Especially the cold, matter-of-fact way the bombshell news was delivered by doctors treating Collin.
“We went to the hospital,” Jan says, and they called us out into a corridor, kids running around, parents, and just told us that Colin had become [infected with] HIV.”
By this time their beautiful little boy had become very sick.
Colin Smith with his toys
‘You just couldn’t pick him up’
Colin senior is still haunted by the effect the virus had on his son’s body. ‘You could see every sinew and tendon in his body,” he said.
Jan said: “I think it was about ’89 that we realised because the weight loss was incredible. And we had him home for a little while, and you couldn’t just pick him up.
“We had to use a sheepskin because it hurt him. He would say: ‘Mum you’re hurting, it’s hurting’.”
Colin was treated by Professor Arthur Bloom, who died in 1992. But in the 1980s, he was one of the country’s leading haemophiliac specialists.
However, documents shown at the Infected Blood Inquiry prove Bloom’s research carried great risks and these were never explained to Colin’s parents.
Professor Arthur Bloom, who died in 1992, was one of the country’s leading haemophiliac specialists
There is a record of the first time Colin went into hospital that shows that he had never been treated for his haemophilia at this point.
Previously untreated patients were known to be useful for research as their responses to new treatments could be tracked. Patients exactly like Colin.
Also shown to the Infected Blood Inquiry was a letter from Prof Bloom to a colleague after another visit by Colin to hospital saying he’s been given Factor VIII and acknowledging that even though this was the British version there was still a risk of Hepatitis but that “this is just something haemophiliacs have to accept”.
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And a letter, dated 24 June 1983, from Prof Bloom to colleagues discusses the risk of AIDS. They accept that one possible case of AIDS has been reported.
Colin’s parents are convinced their son was being used in secret trials.
Colin Smith
“I think Colin was just unlucky enough to be born at the right time. Newly diagnosed haemophiliac, never been treated,” his father explained.
“Which is what we were after, because as documentation states that they are cheaper than chimpanzees, you know. You treat a chimp once, you can follow these children throughout their lives. And that’s what was going on.
“And this was going on from the ’70s. Colin was born in 1982. Yet they still infected him. How do you justify that?”
His mother said that they trusted the doctors at the time and never questioned their son’s treatment. “Just when we think back – at the time no, we didn’t. But when we think back, it was just blood tests. Blood tests, blood tests, blood tests.”
Hate campaign
The threat of HIV and AIDs was only just emerging. And this ignorance drove a hate-fuelled campaign against all those impacted.
This stigma forced Colin and Jan to move home and be shunned by some of their own community. All while still caring for their dying son.
“It became public when he needed to start school, for nursery, and all the parents protested and said: ‘We’re not having an AIDS kid in this school’, because we’ve been known as the AIDS family. We had AIDS that were [written] on the house and you’re not talking little.
“Well, it was like six-foot letters ‘AIDS DEAD’, we had crosses scraped into the door. The phone calls in the middle of the night were not very nice. They were the worst.”
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As Colin’s condition deteriorated his parents decided to bring him home for what would be his last Christmas with the family. It was against the wishes of Prof Bloom.
Jan and Colin were told haemophiliacs with AIDS should die in hospital and be cremated quickly. But the family ignored the hospital.
“And you know what,” Jan says. “He asked for a bike. And we actually got him a bike. He never rode it, obviously because he was too ill. But he wanted a bike. And I’m not going to not get him a bike. Because they all have bikes. But Colin never, never even sat on one.”
Colin Smith spent his last Christmas at home, against the wishes of Professor Bloom
That difficult decision to remove Colin from hospital to spend his last days with his family at home proved to be the right one.
“He was on my lap and he just got up to you, didn’t he?” Jan says looking at her husband. “He said: ‘I can’t see, daddy. I can’t see’. And then he just lay back. My hand was on his chest.
“And, you know, for a mother to actually feel the rise and fall of his chest. Waiting for it to stop. Because that’s what I was doing.
“I was waiting for it to stop. And then it stopped. And I just said: ‘I think he’s gone’. And I remember shaking him a little bit, but he’d gone.”
Jan and Colin Smith speaking to Sky News
‘I want my son to have his name back’
On Monday, Sir Brian Langstaff will deliver the long-awaited report into the infected blood scandal.
It has taken campaigners like Jan and Colin decades to achieve this. They are clear on what this report must say and how the government must respond.
Colin senior lives with the guilt of not protecting his son. He wants accountability.
“I want justice to be served properly not hypothetically. Let’s see the people who did this, hopefully criminal charges. It is manslaughter at least. I gave my son over to his killers, you know, and I can’t get to grips with that,” he says.
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Blood scandal ‘the worst thing’
For Jan, it will be recognition for a lifetime of heartbreak and grieving.
“I want people to recognise my son. And I want to be able to go to the cemetery and say, we’ve done it. And you’ve done it. That’s what I want. And I want an apology.
“People say it’s the money, it’s not the money. And I can’t get that through to people. It’s not the money. I want recognition.
“I want my son to have his name back. His name is Colin John Smith. And that’s what I want people to remember.”
Sky News will have full coverage of the infected blood report on TV, online and on the Sky News app on Monday.
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