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
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 service to carry out systematic reviews. It was overseen by the head of that department. It looked at a very wide array of papers—well in excess of 200 across all areas—but the papers that have got most attention are the ones that focus on puberty blockers and masculinising and feminising hormones; 102 papers were included in that search. There has been significant misinformation about those papers. I hope that that has now been corrected in everyone’s minds but, to be clear, incorrect information was being circulated that indicated that 98 per cent of the papers had been disregarded and that only randomised controlled trials were included. Both of those things are wrong. There were no randomised controlled trials. Two high-quality papers and more than 50 moderate-quality papers were used. Overall, 58 per cent of the 102 papers were included in the analysis, because they were of high or moderate quality. Those papers included a variety of different studies, mainly cohort studies, which follow up and compare groups or look longitudinally. Those studies are not randomised controlled trials, but they are still accepted as good evidence if they are conducted well. The significant weaknesses in most of the literature—I apologise; I have a frog in my throat—was that the follow-up periods were not long enough; that there was significant loss to follow-up, so the studies started off with a larger sample and, because significant numbers dropped out during the course of the study, that made it hard to draw conclusions; and that the comparison groups were not appropriate. The literature was very poor in comparison to most other literature, including in children’s healthcare practice—that was quite striking. The evidence for the efficacy of puberty blockers and masculinising and feminising hormones was weak. We are still unclear about the potential adverse effects of that. I can say a bit more about puberty blockers if the committee would like me to, because that has been a source of contention.
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...