Cass Review - decision to accept the findings: child rights and wellbeing impact assessment

Introduction

1. Brief Summary

This is a decision of a strategic nature relating to the rights and wellbeing of children

Scottish Government accept the findings of the Cass Review: Implications for Scotland findings report from a senior multidisciplinary clinical team within the office of the Chief Medical Officer.

In April 2024 the Chief Medical Officer of the Scottish Government established a multidisciplinary clinical team to consider, in the context of Scottish services, the final report and recommendations of the NHS England The Independent Review of Gender Identity Services for Children and Young People (The Cass Review) commissioned by NHS England and NHS Improvement in Autumn 2020 to make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence.

The multidisciplinary team included senior clinical, paediatric, pharmaceutical and nursing expertise and was written with the intention of framing the Scottish Government's response to the Cass Review final report through a clinical lens and from a Scottish NHS context to ensure that the services provided in Scotland have children and young people at their centre.

The multidisciplinary findings report was published on 5 July 2024 and lays out a number of findings and suggestions for future work regarding the delivery of young people’s gender identity healthcare in Scotland.

The strategic decision is that Scottish Government accepts the findings of the report and then takes forward work to action the report’s recommendations to improve gender identity healthcare for children and young people in Scotland.

Start date of proposal’s development: 6 July 2024

Start date of CRWIA process: 29/08/2024

2. With reference given to the requirements of the UNCRC (Incorporation) (Scotland) Act 2024, which aspects of the proposal are relevant to children’s rights?

While there is potential for this decision to positively impact article 24, at this stage, the acceptance of taking forward these recommendations is too far removed from the specific implementation of these recommendations to assess the impact accurately. It is implementation that will produce impactful actions.

Therefore, this CRWIA has been assessed as neutral in terms of impact due to the fact that future work to implement these recommendations will have CRWIAs prepared and published, and those will focus on the specific impact of actions and the evidence gathered to inform the impact of actioning these recommendations. While the decision to accept these recommendations is expected to progress work to take these forward, we do not believe at this stage impact can be accurately or meaningfully determined either way.

3. Please provide a summary of the evidence gathered which will be used to inform your decision-making and the content of the proposal.

The Cass Review: Implications for Scotland report (Cass Review - Implications for Scotland (www.gov.scot)) was developed by a multidisciplinary team

The report applied a ‘systems thinking’ methodology to engage with key stakeholders to test and build a shared understanding of the current care pathway for children and young people with gender identity issues to ensure recommendations were person-centred, coherent, and likely to succeed.

This included:

• Scottish Government Chief Scientist Office
• Scottish Government Directorate for Chief Nursing Officer
• Directorate for Chief Operating Officer, NHS Scotland – Scottish Government
• Directorate for Population Health, Scottish Government
• Directorate for Health and Social Care Finance, Digital and Governance Scottish Government
• Directorate for Mental Health, Scottish Government - Children, Young People, Relationships and Families
• Scottish Government Directorate for Children and Families
• Improving Health and Wellbeing Division - Maternal and Infant Health, Supporting Maternal and Child Wellbeing, Supporting Disabled Children and Young People Office of the Chief Social Work Adviser
• Children’s Rights, Protection and Justice Division
• Care Experience and Whole Family Wellbeing Division
• The University of Glasgow, School of Cardiovascular and Metabolic Health
• Healthcare Improvement Scotland
• NHS Education for Scotland
• NHS National Services Scotland
• NHS Greater Glasgow and Clyde and NHS Lothian Health Boards
• The Royal College of Paediatric and Child Health
• The Directorate for Learning, Scottish Government
• Service clinicians including psychologists, psychiatrists and paediatricians.
• The National Gender Identity Healthcare Reference Group

The work also reviewed the results of a range of unpublished lived experience consultation that has taken place as part of ongoing national work in Scotland to improve gender identity healthcare.

All this evidence was used to formulate the findings and report recommendations.

However as in response to question 2 this CRWIA covers only the decision to accept the findings/recommendations of the report and the CRWIA has been assessed as neutral in terms of impact due to the fact that future work to implement these recommendations is in the early stages and will have CRWIAs prepared and published on the specific impact of actioning these recommendations and the evidence gathered to inform the impacts of these recommendations.

4. Further to the evidence described at ‘3’ have you identified any 'gaps' in evidence which may prevent determination of impact? If yes, please provide an explanation of how they will be addressed

The findings report concluded that there needs to be a wider understanding of the needs and provision of safe and effective treatments for this population.

The NHS in Scotland is engaging actively with NIHR and NHS England regarding participation in their forthcoming research study on puberty-suppressing hormones.

The Scottish Government has already awarded a grant to the University of Glasgow to administer a programme of research into the long-term outcomes of people accessing gender identity healthcare.

These will inform evidence gathering for future CRWIAs taking place to inform practical work to implement these recommendations.

5. Analysis of Evidence

As in response to question 2 this CRWIA covers only the decision to accept the findings/recommendations of the report and the CRWIA has been assessed as neutral in terms of impact due to the fact that future work to implement these recommendations is in the early stages and will have CRWIAs prepared and published on the specific impact of actioning these recommendations and the evidence gathered to inform the impacts of these recommendations

6. What changes (if any) have been made to the proposal as a result of this assessment?

No changes made.