Following the near-400-page Cass Report, adult transgender clinics in England will now face an inquiry into patient care.

Following revelations from whistleblowers, NHS England has announced a review of seven specialist adult transgender clinics.

Adult transgender clinics across England are set to undergo a rigorous inquiry similar to the recent Cass review, focusing on patient treatment practices. This decision by NHS England aims to address the concerns raised about the quality of care provided at these facilities.


The initiative will start with “external quality improvement experts” visiting each clinic to collect data and insights on patient care.  The announcement follows the release of a landmark report by Dr. Hilary Cass, who advocated for significant changes in how the health service manages care for under-18s uncertain about their gender identity.

In response to the Cass report, NHS England has communicated to the trusts hosting these adult gender dysphoria clinics (GDCs) about their upcoming review. This review is expected to mirror the approach taken with pediatric services, focusing this time on adult care.

The inquiry’s necessity was highlighted by current and former staff at these clinics, who expressed concerns about clinical practices, especially regarding patients with complex conditions and those undiagnosed.

Mermaids, a charity supporting trans, non-binary, and gender-questioning children, praised the recognition of failures in the current system affecting trans youth. However, they voiced concerns that some report language might be misinterpreted, potentially justifying additional barriers to care for vulnerable trans young people.

Additionally, NHS England plans to compel adult gender dysphoria clinics to release data previously withheld from University of York researchers.

The secrecy maintained by six of the seven trusts during the initial research phase was criticized by Cass, who argued that it obstructed what could have been a pioneering research project. This obstruction was described as coordinated and ideologically driven, complicating efforts to gather valuable data.

Wes Streeting, the shadow health secretary, expressed frustration over these tactics, promising accountability under a potential Labour government. NHS England has warned the trusts involved that non-compliance will lead to mandatory directives to ensure transparency.

Concerns initially raised by whistleblowers in 2018 at the Tavistock and Portman’s gender identity service catalyzed the independent Cass review. These concerns, highlighted by senior psychiatrist Dr. David Bell, warned of inadequate care and called for a halt in hormone treatments for children until better evidence of outcomes was available.

Mermaids welcomed the call for more transparent, high-quality research that supports the provision of timely, holistic, and personalized care for trans children and young people. Meanwhile, Robbie de Santos from Stonewall highlighted the deficiencies in adult gender healthcare in the UK, noting the excessive private costs trans adults incur to circumvent long public waiting lists. Stonewall and other advocacy groups see the review as a critical step toward rectifying these issues and enhancing the healthcare system for transgender adults.