Explainer: Cass, Reviewed

The Cass Review is an inquiry set up in 2020 by the English national health service to look into its provision of paediatric gender-affirming care. The final report is out and it's very bad.

Like Girl, Interrupted, but shit

At 10 AM last Wednesday Canberra time, the British government’s Cass Review dropped its Final Report, and a world imploded.

Alright, let’s back up a bit.

What is the Cass Review?

The Cass Review was an inquiry set up in 2020 by the English national health service, NHS England, to look into its provision of paediatric gender-affirming care.

Gender-affirming care is the general term for the kind of healthcare provided to trans people to help them live as the gender they know they are. The Review was to look into how the NHS provided gender-affirming care to people under 18, and recommend improvements where necessary. At least, that’s what the NHS said at the time.

Since its publication, the Final Report has received a great deal of absolutely scathing criticism from trans people, doctors, scientists, human rights groups, and even journalists. The thrust seems basically to be that the Report demonstrates that the entire Cass Review was just a trans-eliminationist hatchet job.

Having read the Report, I’m inclined to agree.

How did we get here?

A full explanation would cover literally thousands of years: someone once said that if you want to bake an apple pie from scratch, you must first invent the universe. So let’s not back up quite that far.

Let’s instead back up to the end of Britain’s last Normal One About The Queers — 2015. By 1 January that year, marriage equality had become law in all of mainland Great Britain. With the gays safely integrated into the burning house (except in Northern Ireland, but that’s another story), England’s historical core demographic of reactionaries, bigots, and assorted useless tossers found themselves at a loss for something to do.

It didn’t take long for new priorities to be set. First, a Government consultation to make it easier to have your gender legally recognised was thwarted, despite overwhelming public support, by an annihilating fusillade of rhetoric, coming from a sudden pan-political full-court press including everyone from The Guardian to The Times. British trans folk, startled, had no option to hunker down and pray it didn’t get worse.

Guess what happened.

Correct. The Guardian, high off sinking the boot in — presumably realising how The Times gets to feel all the time — started spinning up another pressure campaign. This one was against NHS England’s Gender Identity Development Service (GIDS, also called “the Tavistock” or “the Tavi” after its host clinic) which was England’s public gender care service for trans kids. I won’t say “gender-affirming care” because honestly it wasn’t super affirming even before The Guardian got involved. But it might have accidentally helped some trans kids, and so, as far as the British media was concerned, its ass was grass.

The Guardian’s claim, in a nutshell, was that GIDS was “fast-tracking” trans kids into medical transition. The claims were only bolstered when in February 2019, Marcus Evans, one of the clinic’s governors, quit with a great show of fury, furiously proclaiming the allegations to be true, The fact that his wife, Susan Evans, had left the Tavi over a decade earlier because, according to her, she was angry trans people were getting too much say over trans healthcare, didn’t seem to raise any red flags big enough for The Graun to care.

The story provided an excuse for a scandal, which was confected into an English High Court case, Bell v Tavistock. The ructions from that one were bad enough that I know trans Australians who aren’t over it. The Court in that one ended up finding its way to a judgment saying people under 16 probably weren’t competent to consent to taking puberty-blocking medications, which is absurd for reasons we’ll get into in a sec. That judgment was overturned by the Court of Appeal, which issued an icily polite ruling informing the High Court it was several thousand miles out of line to have made the ruling at all.

But the damage had been done. NHS England, which had stopped prescribing puberty blockers practically the afternoon of the original ruling, stood up a “multi-professional review group” ahead of the Court of Appeal judgment to avoid complying in practice with an order to reinstate them.

And, more importantly, the Government finally had the excuse it needed for the Cass Review.

In September 2020, NHS England issued Terms of Reference for an Independent Review into Gender Identity Services for Children and Young People, to be chaired by Dr Hilary Cass OBE, the former president of the Royal College of Paediatrics and Child Health.

In February 2022, the Cass Review published its Interim Report. It didn’t look good even then — some of Cass’ findings about the evidence base for gender-affirming care were puzzling and ominous. But there were some bright spots. For instance, Cass recommended shutting down the central GIDS and moving care out to a network of regional clinics — as she pointed out, it was unsustainable that all trans kids in England and Wales were being pushed into the Tavi, an underresourced bottleneck undergoing an internal civil war. Many trans people thought that was a surprisingly insightful take, and thought she could maybe be persuaded to move left on the other things. There was hope.

On the morning of Wednesday the tenth, that hope took two through the head.

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What has the Cass Review found?

Exactly what it was told to.

… Is what a cynic would say, and also not very helpful, so let’s try that again.