Rainbow Project expresses concern as Hilary Cass commissioned to carry out gender services review by Health Minister Mike Nesbitt
Paediatrician Hilary Cass is to conduct an assessment of gender identity services provision in the North, it’s been announced.
Health Minister Mike Nesbitt has announced the British cross-bench peer has been asked to specifically consider a proposed move to a Regional Lifespan Gender Service in the North.
The Rainbow Project has expressed concerns at the move.
Mr. Nesbitt said: “I am delighted that the eminently qualified Dr. Hilary Cass has agreed to my request to provide an assessment of the actions being taken in Northern Ireland.
"Last year she published her wide-ranging review into gender identity services for children and young people in the United Kingdom.”
But Scott Cuthbertson, Chief Executive Officer (CEO), of the Rainbow Project, said: “Gender Identity Services in Northern Ireland have been almost completely non-functional for most of the past decade.
"The Health Minister must deliver what he has promised: fit-for-purpose, well-funded and staffed healthcare for trans communities in Northern Ireland.
"He cannot hide behind another review while transgender people and their families across the region are languishing on waiting lists, being failed by their healthcare services.”
Mr. Nesbitt said the proposed new Lifespan Gender Service will bring together the existing Children and Adolescent Mental Health Services (CAMHS) Knowing Our Identity Team and the Adult Gender Service into one model of care, under a single management structure.
Dr. Cass – a retired Consultant Paediatrician and a former president of the Royal College of Paediatrics and Child Health - recently completed a review of gender identity services for children and young people in England.
She published her final report – commonly referred to as the Cass Review – in 2024.
Following the review puberty blocker treatments for young people aged under 18 were banned in Britain with the North following suit last August.
Mr. Nesbitt said: “Whilst understandably much of the focus of her report centred on the recommendation on puberty blockers – which Northern Ireland rightly adopted – she also came to other important conclusions.
"In finding that most young people experiencing gender-related distress would not benefit from a medical pathway she instead called for a much stronger focus across the UK on psychological support, as well as a more holistic approach to care.
“That is exactly what I want Northern Ireland to be delivering. Much of the previously approved £806,000 business case for the new Lifespan Gender Service is to invest in new and additional psychological and psychiatric support, as well as a greater multi-disciplinary approach. From my reading of the Cass Review that is exactly the direction of travel she has recommended.
“While I am content with the process undertaken to develop the revised service, in response to a number of questions being raised, I believe an independent expert assessment of the service may go some way to address these issues. I am delighted that Baroness Cass has agreed to complete that assessment which will commence in November 2025.”
The Rainbow Project, however, has warned that a Cass Review for the North will struggle to sustain confidence among transgender people.
The LGBTQIA+ charity also pointed to long-waiting lists for services that need to be addressed urgently.
Mr. Cuthbertson said: “We wholeheartedly support the delivery of evidence-based, research-led trans healthcare. The Cass Review, however, led to the shuttering of services and the withdrawal of care for trans people across the UK, and supported a model which views transitioning as a negative outcome for patients.
"Patient-centred and user-led services are the foundation for improving health outcomes; we believe a Cass-led review in Northern Ireland will struggle monumentally to have the trust and confidence of trans communities, and will indeed worsen an already broken system.”
“The previous review of gender identity services in Northern Ireland, commissioned by Robin Swann in his position as Minister for Health, concluded earlier this year with a recommendation of additional funding and staffing measures to restart the service, as well as moving to a new ‘lifespan’ model which removes barriers for young people moving from the under-18s to the adult service.”
Alexa Moore, Policy Campaigns and Communications Manager at The Rainbow Project and co-chair of the former Service User Input Panel to the Gender Identity Service Review, added: “Trans people and their families poured their heart and souls into the local review of Gender Identity Services, commissioned by the Department and led by the Strategic Planning and Partnership Group.
“This announcement of yet another review, rather than getting on with the job of providing fit-for-purpose gender affirming care will be devastating to all those who gave so much of themselves over the past six years.
"Trans people here deserve better than a Minister who, once again, wants to kick the can down the road rather than delivering meaningful improvements to their lives.”
The Rainbow Project has called for the immediate funding, staffing and commissioning of services, with no further delay to the ‘provision of appropriate gender affirming care to transgender people’ in the North.
According to the Department of Health ‘the Regional Lifespan Gender Service in Northern Ireland will provide age-appropriate support and treatment for individuals experiencing gender dysphoria or who are exploring their gender identity’.
"It is important to note that referral to the service is not gender affirming. It is an administrative step that initiates access to comprehensive evaluation by specialist multi-disciplinary teams. A referral or assessment does not imply automatic access to affirming treatments or pre-empt clinical outcomes,” the department stated.