When lobby groups seize control of the agenda, elected politicians are our final line of defence. The Cass Review, published this week, starkly displays the devastating consequence of an NHS captured by campaigners and activists — a process from which ministers have been too often excluded. Across her four-hundred-page report, Dr Hilary Cass meticulously documents the profound failings of NHS care for gender distressed children, with little democratic accountability. 

Incalculable harm has been inflicted upon thousands of children at the hands of inadequate NHS gender identity services

Doctors and clinicians have been led astray by activist groups seeking to misrepresent data to favour their agendas. They have been convinced to prescribe puberty blockers and cross-sex hormones on the basis of “remarkably weak evidence”. They were told that without dramatic medical interventions, like drugs and double mastectomies, gender distressed children were at risk of suicide, self-harm, and depression. In reality, there was “no evidence” that drugs like puberty blockers “improve body image or dysmorphia” and some evidence that children who are permitted to transition are at higher risk of suicide than those who don’t. 

Incalculable harm has been inflicted upon thousands of children at the hands of inadequate NHS gender identity services. The report will make for tough reading for those that have previously sought to shelter the NHS from necessary scrutiny. Thankfully, it has prompted many politicians to speak out on the problem: for example, Wes Streeting MP, Shadow Health Secretary, has committed a potential Labour government to implementing the “expert recommendations of the Cass review, to ensure that young people are receiving appropriate and high-quality care”. This pivot may come as a surprise to MPs like Rosie Duffield and Tonia Antoniazzi who were ignored and denigrated by their party for years after raising concerns about child transition.

It is good to see that politicians have finally come to their senses and condemned the mistreatment of children. The Cass Review contains many important recommendations: hopefully we will now see decisive action taken to prevent the private provision of puberty blockers to children under 18, statutory safeguarding guidance for schools, and processes put in place to prevent under-age children being treated by adult gender services — all things Policy Exchange has consistently called for.

However, simply implementing Cass’ recommendations is far too little too late. It is not enough to patch holes in a broken system after decades of failure. We need to ask the basic question: how was the situation allowed to get to this point? 

Who are the activist groups who have influenced clinical services and institutional culture? Mermaids, a charity established to “support” transgender children, made referrals to Tavistock even when a child’s GP refused. Stonewall, a pro LGBT+ pressure group, has been repeatedly involved in controversies over its position on transgender issues. Despite this record, they have been allowed to help draw up gender policies for thirty NHS trusts. Previous Health ministers have warned against Stonewall’s influence, but they have not been able to prevent it. This begs the question as to whether current ministerial powers are sufficient to ensure there is wholesale implementation of these measures — something that Streeting queried in a recent interview. This is vital to ensuring a genuinely national approach for matters such as these.

In the past, the NHS has commissioned a “rainbow badge” scheme in partnership with the LGBT Foundation and Stonewall. The scheme warned doctors not to use “gendered language” like “woman” or “mother”. Activist influence led doctors to fear they might be branded “transphobic” for speaking out against harmful gender ideology and child transition, deterring whistle-blowers from raising the alarm about the state of gender services.  Ministers must intervene to ensure Stonewall’s pernicious presence is rooted out of public life. Opposition parties too: has Labour done a full audit of what it means to be a “proud member of the Stonewall Diversity Champions Programme”? 

Similarly, Dr Cass makes it clear in her report that NHS clinicians were profoundly confused by the World Professional Association of Transgender Health (WPATH). They were convinced by WPATH guidelines of a clinical consensus in favour of youth transition and medical intervention when this simply isn’t true. 

The scale of WPATH’s influence is clear. NHS guides for GPs and other healthcare staff have been “informed by the seventh edition of the World Professional Association of Transgender Health (WPATH) Standards of Care”; documents from the Tavistock clinic stated doctors will follow a “modified version of the WPATH Standards of Care v7”; and two NHS Foundation Trusts link healthcare professionals to the current version of WPATH Standards of Care. An activist, not-for-profit organisation continues to steer NHS policy with impact upon clinical service delivery on the basis of ideology.

These activist pressure groups have been allowed to infiltrate and influence NHS organisations without any high-quality clinical evidence for the care they recommended. The Cass Review must represent a watershed moment for impartiality, in public life — on both political and cultural grounds. Progress is already being made; the rainbow badge scheme has been wound up and Victoria Atkins has called for the full cooperation of clinics who refused to provide evidence to the review. 

Professional autonomy does not just mean “operational independence” from Ministers. Critically, it also must mean independence from lobbyists seeking to shape policy. Elected politicians, accountable to the public, remain the best bulwark against NHS capture by those interest groups.