NHS England plans to open up to six regional gender centres for young people by 2026

NHS England has published a plan to open up to six new regional gender services for young people by 2026.

The plan was published online on Wednesday (7 August) and follows the Cass review in April. The review, led by Dr. Hillary Cass, a former president of the Royal College of Paediatrics and Child Health, was commissioned by the previous Conservative government to look into gender the provision of gender-affirming care for trans people in England.

Across 400 pages Cass made 32 recommendations including for young people to get “a holistic assessment of their needs to inform an individualised care plan.” The review also recommended moving away from a single national service towards a series of regional centres.

Gender services in England have already started to move towards a regional model after the closure of the gender clinic at the Tavistock and Portman NHS Foundation Trust. Two new NHS Children and Young People’s Gender Services at London’s Great Ormond Street Hospital (GOSH) and Alder Hey Children’s Hospital in Liverpool opened in April.

The review also led the NHS to stop the routine prescription of puberty blocker treatments to under-18s. The Conservatives then placed a temporary ban on the prescription of puberty blockers which the new Health Secretary, Wes Streeting, has faced criticism for wanting to make permanent.

On Wednesday NHS England set out how it was planning to change gender services in England following the Cass review. It said it will continue to establish up to six new regional centres by 2026. The next one is due in Bristol by November 2024 that over time is aimed to help people from south Wales too. Another centre will be established in the East of England with Cambridge University Hospitals NHS Foundation Trust between 2024 and 2025. The goal will be to have one service based in a children’s hospital in each of region of England.

“It just feels like it’s England diverging from the international consensus” – Dr Aidan Kelly

The creation of a new National Provider Collaborative will ensure a consistent approach to service delivery, research, and auditing. Each centre will then have a nominated paediatrician or psychiatrist in charge of patient safety.

NHS England has also said the service will consider young people’s wider health more “holistically.” New referrals to gender services will have to be made through mental health or pediatric services “to ensure every child or young person has had a thorough assessment of need.” Both points act on recommendations from the Cass review.

The plan also included an ambition to start clinical trials into the effects of puberty blockers on young people can begin from 2025. This is likely to be controversial with LGBTQ+ groups, charities, and some medical professionals. Upon the publication of the Cass review, many took issue with the review’s decision to reject some research around puberty blockers. Speaking to Attitude, Dr Aidan Kelly, a Consultant Clinical Psychologist and the founder of Gender Plus and the Gender Plus Hormone Clinic, the only independent Care Quality Commission registered gender identity clinic serving children and adults, highlighted a recent German report, similar to the Cass review, which was very supportive of puberty blockers. “It just feels like it’s England diverging from the international consensus. It’s quite an insular position that’s been taken,” he said.

NHS England has also published plans for a review into adult gender services. This will include engagement with interested parties and a consultation before hopefully being implemented in April 2025.

“NHS England is setting up a clinical trial to establish the evidence on puberty blockers” – Wes Streeting

Professor James Palmer, the NHS medical director for specialised commissioning, has described the Cass review as “the backbone on which our implementation plan is based.” Commenting on the plans he added: “There remains considerable work to do.”

Meanwhile, Professor Sir Stephen Powis, the NHS’ national medical director, said: “The work Dr Cass has undertaken has been invaluable in helping us shape the new service offer.”

Labour’s Health and Social Care Secretary Wes Streeting said he’s pleased to “fully implement” Cass’ recommendations “so that young people get the safe, holistic care and support they need.” He went on to say: “The unacceptable waiting times for gender services cause enormous distress to children and young people, at a crucial point in their lives. As well as rolling out new services, NHS England is setting up a clinical trial to establish the evidence on puberty blockers, because children’s healthcare should always be led by evidence. I want trans people in our country to feel safe, accepted, and able to live with freedom and dignity.”

In response to the plans, the trans charity Mermaids has said: “These updates largely outline what we already know about NHS England’s approach. However, we’ll be reviewing them in detail and, alongside sector partners, will provide further information, analysis and resources in due course.”