Specialist gender services for children and young people: progress report

Cass Review and NHS Scotland Next Steps

14. On 9 April 2024 NHS England's Independent Review of Gender Identity Services for Children and Young People, chaired by Dr Hiliary Cass ('The Cass Review'), published its final report. This review was commissioned by NHS England and NHS Improvement in autumn 2020 to examine and make recommendations about clinical services provided by them to children and young people. In December 2020 Scottish Government committed to closely consider the Cass Review's findings as they became available, confirming it would not seek to duplicate the review for an NHS Scotland context. Scottish Government officials, Deputy Chief Medical Officers and NHSGGC proactively engaged with Cass Review team and met with Dr Cass on several occasions throughout the life of the review.

15. On 23 April 2024 the Minister for Public Health and Women's Health advised Parliament the Chief Medical Officer (CMO) had agreed to establish a multi-disciplinary clinical team (MDT) within the Office of the Chief Medical Officer Directorate to assess the Cass Review's final recommendations and engage with relevant clinical leadership in Health Boards in relation to those. That MDT included nursing, paediatric, pharmacy and mental health expertise.

16. The clinical MDT considered all 32 recommendations made by Dr Cass and assessed to what extent they were applicable in the Scottish context and provided a view on whether they could or should be implemented. Pre-election guidance prevented this update from being provided before the UK General Election. That report was subsequently provided to Parliament on 5 July 2024.

17. The conclusions of the MDT report have now been considered and accepted by the Scottish Government. Amongst the report's findings, is that the current de-facto national provision for children and young people in an adult sexual health service at Sandyford should be relocated to a paediatric clinical setting.

18. Commissioning of this new service will take place in two phases. Firstly, in line with the new planning and commissioning approach to fragile services, development of a delivery model to address the immediate term fragility that will consider how we best plan with current resources (a Sustainable Operating Model) and then a longer term model that will align with wider planning of health services (Target Operating Model) considering future skills and demand.

19. This work will be overseen by the Chief Operating Officer Directorate within Scottish Government, with assistance from Health Board clinical and management colleagues. This process will permit any care pathway, amongst other aspects, to be reviewed in line with national requirements and the whole of a clinical offering to be more effectively integrated into other secondary care pathways, relevant to this specialist care. This may include establishing satellite clinics.

20. This work is already underway and will represent a substantive shift from how care is currently both commissioned and managed. This process represents a refreshed opportunity to provide high-quality, person-centred specialist care in this field.

2021 Framework – Supporting Research

21. Closely linked to the above commissioning work are ongoing commitments and workstreams relevant to improving the research and evidence landscape for gender identity healthcare for children and young people. The importance of this was highlighted in the 2021 Framework, the Cass Review's final report and MDT Report to Parliament on 5 July 2024.

University of Glasgow – Scottish Government Grant Funding

22. The 2021 Framework committed to work with the Chief Scientist Office (CSO) (Health) to develop research proposals, and make funding available, for additional research on long term health outcomes for those accessing gender identity healthcare in Scotland.

23. Following CSO agreed processes, the Scottish Government subsequently confirmed the award of grant funding to the University of Glasgow in January 2023 to administer a programme of small research grants for this purpose.

24. Research projects funded via this programme include work exploring the physical health in young people with gender dysphoria as well as on young people's experiences of wellbeing and development, including emotional, social, physical wellbeing and intellectual/vocational attainment before and after accessing specialist services.

25. The first outputs of the above programme are expected to be available from the end of 2024.

National Institute for Health and Care Research – Puberty Blockers

26. The Scottish Government has proactively engaged with NHS England and the National Institute for Health and Care Research (NIHR) to explore opportunities for NHS Scotland to fully participate in a proposed UK-wide commissioned research study on puberty suppressing hormones, as a treatment option for gender dysphoria. Both NHSGGC and the University of Glasgow subsequently joined this engagement process as clinical and academic partners.

27. Following a process of engagement to better understand outcomes and practicalities associated with the NIHR-led research study, the Chief Scientist (Health) has now confirmed to NIHR that NHS Scotland wishes to join this study as a full participant, at the most appropriate stage. Further details will be confirmed as the NIHR study development continues.