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.”
The last blast furnaces left operating in Britain could see their fate sealed within days, after their Chinese owners took the decision to cut off the crucial supply of ingredients keeping them running.
Jingye, the owner of British Steel in Scunthorpe, has, according to union representatives, cancelled future orders for the iron ore, coal and other raw materials needed to keep the furnaces running.
The upshot is that they may have to close next month – even sooner than the earliest date suggested for its closure.
Read more: Thousands of jobs at risk as British Steel consults unions over closure
The fate of the blast furnaces – the last two domestic sources of virgin steel, made from iron ore rather than recycled – is likely to be determined in a matter of days, with the Department for Business and Trade now actively pondering nationalisation.
The upshot is that even as Britain contends with a trade war across the Atlantic, it is now working against the clock to secure the future of steelmaking at Scunthorpe.
The talks between the government and Jingye broke down last week after the Chinese company, which bought British Steel out of receivership in 2020, rejected a £500m offer of public money to replace the existing furnaces with electric arc furnaces.
The sum is the same one it offered to Tata Steel, which has shut down the other remaining UK blast furnaces in Port Talbot and is planning to build electric furnaces – which have far lower carbon emissions.
These steel workers could soon be out of work
However, the owners argue that the amount is too little to justify extra investment at Scunthorpe, and said last week they were now consulting on the date of shutting both the blast furnaces and the attached steelworks.
Since British Steel is the main provider of steel rails to Network Rail – as well as other construction steels available from only a few sites in the world – the closure would leave the UK more reliant on imports for critical infrastructure sites.
However, since the site belongs to its Chinese owners, a decision to nationalise the site would involve radical steps government officials are wary of taking.
They also fear leaving taxpayers exposed to a potentially loss-making business for the long run.
The dilemma has been heightened by the sharp turn in geopolitical sentiment following Donald Trump’s return to the White House.
The incipient trade war and threatened cut in American support to Europe have sparked fresh calls for countries to act urgently to secure their own supplies of critical materials, especially those used for defence and infrastructure.
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Gareth Stace, head of UK Steel, the industry lobby group, said: “Talks seem to have broken down between government and British Steel.
“My advice to government is: please, Jonathan Reynolds, Business Secretary, get back round that negotiating table, thrash out a deal, and if a deal can’t be found in the next few days, then I fear for the very future of the sector, but also here for Scunthorpe steelworks.”
British Steel declined to comment.
UK
Prince Andrew’s Pitch@Palace branded ‘crude attempt to enrich himself’ as Chinese spy documents set to be released
Prince Andrew’s efforts to make money from his Pitch@Palace project have been branded as a “crude attempt to enrich himself” at the expense of “unsuspecting tech founders”, as new documents may shed more light on what he and his team have been attempting to sell.
Today is the deadline for documents to be released relating to Prince Andrew‘s former senior adviser Dominic Hampshire and his interactions with the alleged Chinese spy Yang Tengbo.
In February, an immigration tribunal heard how the intelligence services had contacted Mr Hampshire about Mr Yang back in 2022. Mr Yang helped set up Pitch@Palace China, a branch of the duke’s scheme to help young entrepreneurs.
The alleged Chinese spy, Yang Tengbo, has links with Prince Andrew
Yang Tengbo. Pic: Pitch@Palace
Judges banned Mr Yang from the UK, saying his association with a senior royal had made Prince Andrew “vulnerable” and posed a threat to national security. Mr Yang challenged that decision at the Special Immigration Appeals Commission (SIAC).
Since that hearing, media organisations have applied for certain documents relating to the case and Mr Hampshire’s support for Mr Yang to be made public. SIAC agreed to release some information of public interest. It is hoped they may include more details on deals that he was trying to do on behalf of Prince Andrew.
So what do we know about potential deals for Pitch@Palace so far?
In February, Sky News confirmed that palace officials had a meeting last summer with tech funding company StartupBootcamp to discuss a potential tie-up between them and Prince Andrew relating to his Pitch@Palace project.
The palace wasn’t involved in the fine details of a deal but wanted guarantees to make sure it wouldn’t impact the Royal Family in the future. Sky News understands from one source that the price being discussed for Pitch was around £750,000 – there are, however, reports that a deal may have stalled.
Photos we found on the Chinese Chamber of Commerce website show an event held in Asia between StartupBootcamp and Innovate Global, believed to be an offshoot of Pitch.
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Who is alleged Chinese spy, Yang Tengbo?
Documents, released in relation to the investigations into Mr Tengbo, have also shown how much the duke has always seen Pitch as a way of potentially making money. One document from 21 August 2021 clearly states “the duke needed money at the time, and saw the relationships with China through Pitch as one possible source of funding”.
But Prince Andrew’s apparent intention to use Pitch to make money has led to concerns about whether he is unfairly using the contacts and information he gained when he was a working royal.
Norman Baker, former MP and author of books on royal finances, believes it is “a crude attempt to enrich himself” and goes against what the tech entrepreneurs thought they were signing up for.
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He told Sky News: “The data given by these business people was given on the basis it was an official operation and not something for Prince Andrew, and so in my view, Prince Andrew had no right legally or morally to take the data which has been collected, a huge amount of data, and sell it…
“And quite clearly if you’re going to sell it off to StartupBootcamp, that is not what people had in mind. The entrepreneurs who joined Pitch@Palace did not do so to enrich Prince Andrew,” he said.
Rich Wilson was one tech entrepreneur who was approached at the start of Pitch@Palace to sign up, but he stepped away when he spotted a clause in the contract saying they’d be entitled to 2% equity in any funding he secured.
He feels Prince Andrew is continuing to use those he made a show of supporting.
He said: “It makes me feel sick. I think it’s terrible – that he is continuing to exploit unsuspecting tech founders in this way. A lot of them, I’m quite grey and old in the tooth now, I saw it coming, but clearly most didn’t. And a lot of them were quite young.
“It’ll be their first venture and you’re learning on the trot, so to speak. So to take advantage of people in such a major way – that’s an awful, sickening thing to do.”
We approached StartupBootcamp who said they had no comment to make, and the Duke of York’s office did not respond.
With reports that a deal may have stalled, it could be a big setback for the duke – especially with questions still about how he’ll continue to pay for his home on the Windsor estate now that the King no longer gives him financial support.
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