Gender services should take a 'holistic' approach in Scotland
A report has advised following England in pausing puberty blocker use until after further clinical trials
A report looking into how the Cass Review might apply to NHS services in Scotland says they should focus on a “holistic” approach to gender identity services.
The review from Dr Hilary Cass examined gender care services in England, criticising the lack of evidence around the use of puberty blockers, amongst other forms of medical intervention.
The report has been submitted to the Scottish Government by a multi-disciplinary team established to consider the Cass Review’s impact on Scotland.
It was overseen by the Chief Medical Officer Sir Gregor Smith, and considered all 32 recommendations of the review, as well as how applicable they are in Scotland, including if they could be implemented to the health service.
"Our ambition must remain focused on meeting their needs"
Scotland's Deputy Chief Medical Officer Professor Graham Ellis said: "The Cass Review was established to make recommendations on how to improve NHS England gender identity services for children and young people.
"Through this review we have aimed to set out which recommendations could apply to Scotland, and how they might be implemented.
"At the heart of this question are children and young people in distress, and our ambition must remain focused on meeting their needs with holistic, person-centred care as close to home as practical.”
Overall responsibility should be taken over each young person’s care by a lead senior clinician, preferably a consultant, with each care plan considering a full assessment of the child’s psychological and physical needs, according to the report’s recommendations.
"Holistic, person-centred care"
It also suggested that, as with elsewhere in the UK, use of puberty suppressing hormones – or puberty blockers – should be paused until further clinical trials can be undertaken.
NHS Scotland will continue to engage in the forthcoming UK study.
Continuing, Professor Ellis said: “The Cass Review identified the need to ensure that gender identity services for young people are more closely aligned with other areas of clinical practice, and that responsibility for the full range of services required should extend beyond specialist services. This will be essential as we seek to always provide the best possible care.
"In responding to the Cass Review, the multi-disciplinary team looked at the recommendations from a clinical perspective, always remembering that we have a responsibility to make sure that all children and young people grow up safe, respected and supported."
Work to design regional services should begin immediately
Following the publication of the Cass Review in April, two Scottish health boards - one of which covers the only gender clinic in the country for young people - decided to pause the prescription of puberty blockers to new patients.
The report led by Sir Gregor recommends that work to design a regional service for children and young people should begin immediately, and services should ultimately be provided as locally as possible, based in children's health services, with strong links between secondary and specialist services.
Pre-election rules prevented publication in the run-up to the General Election, but a commitment was made to the Scottish Parliament to publish at the first opportunity after the restricted period ended.
The conclusions of the report will now be considered by the Scottish Government.
"We remain absolutely committed...to reforming and improving gender identity healthcare"
Health Secretary Neil Gray said: "The Scottish Government welcomes the multi-disciplinary team's report, which has carefully considered the Cass Review's recommendations and how they apply to Scotland.
"The conclusions of the report will now be considered and used to improve gender identity healthcare for children and young people.
"The Scottish Government will update Parliament after summer recess.
"We remain absolutely committed not just to ensuring ongoing support is available, but to reforming and improving gender identity healthcare across Scotland."