Committee
Health, Social Care and Sport Committee 07 May 2024
07 May 2024 · S6 · Health, Social Care and Sport Committee
Item of business
Gender Identity Services for Children and Young People
Dr Cass
Watch on SPTV
It is important that young people get a holistic assessment. That includes looking at all aspects of their presentation and trying to understand their gender questioning in the context of other issues that are happening for them. One of the problems in focusing only on gender is that you can end up putting somebody on an endocrine pathway when you have not addressed the fact that they have undiagnosed autism, they are out of school, they are not participating or there is family breakdown—all those other factors. It is about seeing them as a young person first and understanding the gender distress through that lens, and, I think, accepting that two things are simultaneously true: first, that a small number of these young people will benefit from a medical pathway for their gender distress; and, equally, that for probably a larger number their gender distress will be resolved in myriad other ways—whether that is that it has been a developmental questioning period that spontaneously resolves, whether they resolve uncertainty about their sexuality and then their gender questioning resolves or whether they find that they do not want a very rigid medical pathway but just remain gender fluid or gender non-conforming in the longer term. It is about being open, exploring and making sure that options are not foreclosed too soon for that young person. That is probably the single most important takeaway.
In the same item of business
The Convener
SNP
Agenda item 2 is an evidence-taking session with Dr Hilary Cass on her review of gender identity services for children and young people, which was commission...
Ruth Maguire (Cunninghame South) (SNP)
SNP
Good morning, Dr Cass. Thank you for being with us this morning. Your review is obviously a detailed piece of work that needs careful consideration. We all a...
Dr Hilary Cass (Cass Review)
Yes. As will be clear from the report, the main concern for me was the weakness of the evidence base across all aspects of care. The critical issue is the ne...
Ruth Maguire
SNP
Thank you—that was helpful.
Tess White (North East Scotland) (Con)
Con
Good morning, Dr Cass. Is there, in the 32 recommendations in what is a very comprehensive report, anything specific in relation to the delivery of services ...
Dr Cass
I would highlight some of the things that I have just alluded to. In England, in particular, we are embedding these services within a broader children’s hosp...
Tess White
Con
I turn to my second question. In your answer to Ruth Maguire’s question, you talked about the importance of the evidence base and collaboration. How do you f...
Dr Cass
I think that it is not for me to comment on any political opinion in Scotland. My job is just to comment on the evidence as I see it, but if those opinions w...
The Convener
SNP
Dr Cass, what key conclusions in relation to future provision for gender services would you want practitioners in Scotland to draw from the review?
Dr Cass
It is important that young people get a holistic assessment. That includes looking at all aspects of their presentation and trying to understand their gender...
The Convener
SNP
Thank you for that answer.
Ivan McKee (Glasgow Provan) (SNP)
SNP
Good morning, Dr Cass, and thank you for spending some time with us this morning. You rightly mention that the evidence base is a hugely important part of ...
Dr Cass
The systematic review was carried out by the University of York, which is one of a small number of organisations that are commissioned by the national health...
Ivan McKee
SNP
We will come on to that in follow-up questions. You have answered some of my supplementary questions as well. You have said, first, that the supposed statis...
Dr Cass
I will address the last point. There has been a question of whether we have set a higher bar for the research and our systematic review—we absolutely have no...
Ivan McKee
SNP
That is great, thank you. Just to be clear, what questions would you hope that the research and future evidence would give us the answers to?
Dr Cass
We want to understand whether there is a small group of young people who do benefit from puberty blockers; we also want to understand what potential negative...
Ivan McKee
SNP
So it would be about looking at physical and mental outcomes from a health perspective.
Dr Cass
Yes—and social outcomes.
Ivan McKee
SNP
And that research would look at people who chose to detransition at a future stage as well.
Dr Cass
Yes, and there has been anxiety about that. The trans community has been concerned that we are looking at detransitioners to say that we should not be giving...
Ivan McKee
SNP
That is great—thank you very much.
Emma Harper (South Scotland) (SNP)
SNP
Good morning, Dr Cass. Thank you for being here this morning. I am interested in the recommendation that young people should remain within the young people’s...
Dr Cass
Yes, there has been a lot of misunderstanding about that recommendation as well, as you rightly say. We proposed it because it is in line with other aspirati...
Emma Harper
SNP
I want to pick up on what you said about the misrepresentation of that recommendation or other parts of the report. You talked about a holistic assessment fo...
Dr Cass
Sorry, but is the bit that you think has been said to be based on dubious science about having a holistic assessment?
Emma Harper
SNP
It is really about the wider recommendation on supporting young people right through the process. The information that we have says that it has been said to ...
Dr Cass
The misrepresentation was that, when we said that young people would not have to transition at that vulnerable time, we meant transition between services, an...
Emma Harper
SNP
It does help, actually—it shows the power of correct words. Thank you.
Sandesh Gulhane (Glasgow) (Con)
Con
I declare an interest as a practising NHS general practitioner. Thank you for joining us, Dr Cass. I have grave concerns about the use of puberty blockers f...