The HSE has published its long-awaited review of the Cass report into the Tavistock gender identity clinic. Although the findings from the internal review were presented to the HSE’s executive management committee on February 21, the full report was only made public yesterday, April 5.

In August last year, a review conducted by Dr Hilary Cass found the Tavistock clinic was struggling to cope with the demand for its services and couldn’t appropriately meet trans people’s needs due to being the sole provider in the UK. 

Dr Cass’s review suggested that a more decentralised approach would be more suitable, and it advised the NHS to open several regional hubs across England to provide gender-affirming healthcare services.

Since August 2012, the HSE has referred Irish patients to Tavistock for psychological assessment under the Treatment Abroad Scheme (TAS). According to the HSE report, since then, a total of 233 referrals have been made by consultants in Ireland to the clinic.

It also found that out of the 5,000 patients currently on the Tavistock waiting list, most recent figures show that “72 of these are previous referrals for children/young people from Ireland.”

In its review, the HSE maintains it was approached by family members of trans youth complaining about the lack of gender-related services in Ireland. It acknowledges that “the slow development of specialist services for children and young people expressing gender dysphoria in Ireland is adding to risk.” 

Despite recent investment commitments, the report also states, “Rather than improving, since the pandemic, service provision for children and young people has fragmented and deteriorated. The course through the clinical pathway is lengthy, so the risk of anxiety and emotional distress for parents and children/young people alike may be heightened by uncertainty and isolation.”

While there had been outside claims that the services provided by the Tavistock clinic were unsafe for trans youth, the internal review conducted by the HSE found that “there is no evidence that hormonal treatment or other physical intervention has been fast-tracked”. In the report, the HSE specified that families had no complaints about the quality of the services provided by the Tavistock clinic.

It also flagged concerns over prolonged waiting lists and lack of access to services in Ireland. One of the families surveyed in the report said, “The mental strain and emotional distress experienced by their children and their family over the course of their transition was immense. Their child experienced social isolation, bullying at school and mental illness.”

They also stated that the approach of the professionals at the Tavistock clinic was “cautious and procedural rather than gender-affirming” and that they were frustrated by how long they had to wait before being prescribed puberty blockers.

The report also confirms, “The HSE will establish a group during 2023 to develop an updated model of care for the treatment of gender dysphoria. The group will be led by an expert clinician from a relevant speciality who will oversee this process and ensure widespread stakeholder engagement.

“The HSE’s goal is to develop a person-centred model of care and invest in an integrated service that meets the needs of transgender people in Ireland.”