Entry 2 – How I’m approaching the Review (March 2021)

Posted in: Journal

Give your evidence,’ said the King; `and don’t be nervous, or I’ll have you executed on the spot. ‘ This did not seem to encourage the witness at all: he kept shifting from one foot to the other, looking uneasily at the Queen, and in his confusion he bit a large piece out of his teacup instead of the bread-and-butter“.

Alice’s Adventures in Wonderland

When I wondered what image an ‘independent review’ might conjure up, I looked up the definition in Collins dictionary and it told me ‘a review of a situation or system is its formal examination by people in authority’. This immediately made me think of a wood panelled room with men and women in grey suits and tweed skirts conducting interviews, drawing conclusions, and making judgements and recommendations. It also told me that ‘an independent inquiry or opinion is one that involves people who are not connected with a particular situation, and should therefore be fair’ and that part of the definition is a principle I am absolutely committed to.

When I reflected on my wood panelled room image, I ticked myself off for stereotyping men in grey suits and women in tweed skirts – although as it happens, I don’t possess either of those items of clothing myself. But it’s not a big jump from stereotyping to developing the sort of prejudice that has been highlighted through the Black Lives Matter movement, the persecution of the Uighurs in China because of their culture and religious beliefs, and the attacks that so many have suffered because of their sexuality or gender identity. But if you can forgive the stereotype, I wanted to put it out there so you know how this review is NOT being conducted.

My role as Chair is to lead a process that will navigate us to the best possible support and treatment for children and young people who need help to understand their gender identity and to make informed choices about the options available to them.

First off, it is important to say that many young people who question their gender identity do not need any help from the NHS; they reach a satisfactory conclusion about the way forward for them, that doesn’t necessitate medical treatment. A smaller proportion do need clinical services. For many of the young people needing to access health services, the mismatch between their birth assigned gender and their gender identity can be intensely distressing; at that point they are said to be suffering from gender dysphoria. So, providing the right treatment to help them should be easy, right? But sadly, it’s not. There are lots of challenges in working out which options are best for which children and young people. We still don’t have enough knowledgeable and skilled staff able to provide support at all points in the young person’s journey through the NHS, and we all know that waiting times for assessment are much too long.

Everyone is much more informed since the Covid-19 epidemic about how the NHS makes decisions and provides treatments. How many times have we heard the phrases ‘follow the science’, ‘wait for the data’ and ‘based on the evidence’? However, gender medicine is still a relatively young speciality, and although there is an increasing number of publications in the field, we don’t have all the data we would like to help guide treatment decisions.

All of this means that I won’t be trying to reach conclusions on my own. We are all in this together. The Review will collate and analyse the research that already exists, but this will still leave us with a lot of knowledge gaps. I am commissioning additional research to address some of those gaps, but that won’t give us all the answers either. Most importantly, I will be tapping into the experience and expertise of those who have first-hand knowledge of the issues, including; children and young people, young adults, parents and carers, teachers, clinical staff and researchers. With my team, we will be finding as many different routes to reach you as we can – and for you to inform us – through one-to-one sessions, hearing individual stories, workshops, and webinars. There will also be opportunities get involved in our research programmes.

Up until now I’ve been frustrated about not having a way to interact with you beyond Twitter, but I am delighted that our Review website is now live at www.cass.independent-review.uk. Although it has taken longer than any of us would have wished, this is because it had to be made secure and safe for everyone using it, and to be opened when we were ready to welcome visitors and participants. That time is now, and I would encourage you to explore an evolving resource that will grow as the Review progresses and our evidence gathering and research programmes get under way.

There will be much more to cover in future blogs about the research we are planning to undertake and how this will help us answer the key questions, so please do subscribe via the website to receive updates. I am looking forward to hearing from many of you who are reading this blog.