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Two ways of implementing the Cass Report

Wes Streeting pledged to implement the Cass Report recommendations wholesale. What does that mean? Depends on how you read the report. 

April 13 2024, 15.11pm

One of the peculiarities of British political culture, for better and worse, is the undying hope that politically contentious issues can be resolved through independent inquiries so professionalised they border on technocratic. But such inquiries rarely provide out-of-the box political resolutions; often as not, their work risks becoming grist to the same mill of contention the fact-finding was meant to have put to rest. 

The Cass Report, looking into increased referrals of young people to  gender identity development services (GIDs), is a case in point. While not without shortcomings, the report's findings can be read as a reasonable, largely constructive contribution to a deeply polarised debate; worlds apart from the unsubstantiated, cavalier proposed government guidance on handling gender questioning in schools, for instance. And far from calling for a blanket stop to hormonal treatments - as some commentators would have us believe -  Dr Hilary Cass calls for more research and more treatment infrastructure, with a more individualised approach to young people exploring or questioning their assigned gender identity.

As preeminent LGBTQ advocacy group Stonewall noted in its response to the report, “What is important, above all, is that trans and gender-diverse children get the quality healthcare that they need and deserve. The Cass Review can play a vital role in achieving this aim, if its recommendations are implemented properly.”

Properly is the operative word here. The centrepiece recommendation of the Cass Report is vast, ambitious, high-investment reform of gender identity development services and associated research. There are two ways of interpreting that - and they entirely depend on what assumptions you bring into your reading.

If your overall suspicion is that gender-questioning is either hypochondria, a fad or a conspiracy; and if your go-to approach to public funding and services on any issue is “as little as possible”, you will read this recommendation as saying that the only way to improve this treatment is through spending sums no fiscally responsible government can afford. You might conclude that the only viable answer is to stop treatment entirely, at least until someone else funds sufficient research. Worse, you might even be tempted to read the part of the report lamenting “lack of evidence” as lack of evidence of the need for treatment as opposed to lack of evidence that hormonal treatment specifically  is as efficacious in answering that need  as its proponents claim, which emphatically not the point of the report.

This has been the overall tone of the response from the rightwing and “gender-critical” commentariat, which tries to spin Dr Cass’s findings as I-told-you-so - an enormous stretch, to say the least. 

If, conversely, you believe in listening to and supporting our young people, not shrugging off their experiences and concerns - even if they are different to those your own generation has allowed itself to speak out on or to hear; if you believe that the fact we still have very little information on the issues affecting an increasing number of said young people means we urgently need more research funds, not less; and if you believe the same about healthcare investment overall - that we need more of it, after 15 years of Tory misrule - you will read this as a call for a generous, thoughtful, ambitious investment to bridge our knowledge gaps and to afford gender-questioning young people all the care and support they require and deserve.  

As on any contentious issue, Labour’s campaign position on trans rights has been frustratingly difficult to ascertain: in the same week, you had Anneliese Dodds pledging to us to ban conversion therapy, and Wes Streeting unequivocally pledging to implement the recommendation of the Cass Report, - with quite a needless rhetorical kick or two some at trans rights progressives. 

But depending on which of the two approaches Streeting is operating on, the two positions need not contradict each other; and as on many things, his true test will be in government, not on the campaign trail. If Streeting gets to make this pledge into policy, that policy would only be valid and responsible if it is based on the second set of values - the values of a true Labour government committed to supporting our young people and repairing our ransacked NHS. This alone would allow Britain to implement the findings of the report, rather than those of the rightwing press.