I have been thinking about how to write this post since 10th April, the day Dr Hilary Cass published her report into gender dysphoria services for children and young people: Final Report – Cass Review. This is a report that Parliamentarians across all sides of the House of Commons have welcomed with a dose of shame and concern that such a scandal of medicalising young people on shaky evidence with no foundations could be possible (Cass Review – Hansard – UK Parliament).

Like many others I have a personal view on these matters, driven through experience of those close to me from all perspectives, parents, teachers and social workers, clinical and therapeutic professionals, gender distressed children, trans-identifying adults and de-transitioners. But my personal position isn’t the focus here.  The focus is openness and transparency, approach to risk, mitigation of risk, willingness to engage with evidence and lack of evidence and divergence of opinion within and across professional disciplines. Each of these has been severely lacking in the discourse about provision of care and support for a vulnerable cohort of children and young people, wrapped up in a culture of “no debate” and driving a fear of curiosity, questioning and challenge to the prevailing orthodoxy pre-Cass Report.

Over the last year or so we have been holding space for a different type of dialogue. One that:

  • Tries to understand unique context, perspective, and intention from all sides (even when we don’t agree).
  • Exploration of data, information, and evidence, some of which has been referenced in the Cass Report and others that are locally driven where we are based or with many stakeholders wider afield.
  • Identification of intent and best self, in service of gender distressed children by professionals in school, social care and education. It is wrong to lump all professions as a homogenous tribe.  There are undoubtedly those acting in ignorance but with the best of intentions seeking advice and poorly served, those who have spoken up to challenge or question prevailing practice but have been silenced, those rogue actors in the system that have contributed to harms to children and young people through ideological dogma, those who have felt scared from speaking out in a toxic culture and those who have been trying their very best in the most trying of circumstances.
  • Creating a safe space to share experiences and views without judgement, embrace dissent and differences in a shared way through high quality dialogue that achieves a collective outcome, rather than debate which, by default, tends to pitch winners against losers, particularly relevant and toxic in situations of major scandal or contention.
  • Individuals acting locally in their situation, community or workplace but making this productive and meaningful as opposed sloganizing or reductive arguments.
  • Achieving accountability.  For some this will be recourse to legal or regulatory action where harm has been caused and damage created.  For others this will be setting a new culture and initiating new conversations within the framework that the Cass Report offers as standards of care. In many sectors those whose professional roles touch the lives of gender distressed children are now navigating how to have better conversations in a post Cass Report era. In many NHS institutions, as with Francis, Keogh and Ockendon before Cass, there will be a period of reflection as to how the culture of our health services systems can strive for greater levels of openness, talking about the tough stuff, challenge across professional boundaries and applying generative listening and productive responses when questions are raised, and challenge provided.

The context for conversations about Cass will remain sensitive tough terrain for some time to come.  The space for dialogue does not negate the personal emotion or attachment people may feel, particularly if they or their family have been affected by these issues. Neither does it negate recourse for justice people may seek if they feel their child has been harmed either through social and medical transition or through a lack of access to care they feel they need. The space for dialogue will set the tone, create the conditions, harness the collective intelligence, and contribute to a better care and support in service of children and young people.

If you are interested in how to kickstart a conversation about Cass, contact us to learn more about what has made these hard to achieve and how it can work well.