Northern Ireland's child transgender NHS service continuing as normal following stark report into quality of 'gender-affirming care'

The Cass report was published on Wednesday, having been commissioned in 2020 amid rising worries about the number of children now saying they are transgender and the way the NHS treats them.

Some campaigners and medics were particularly worried that the NHS had adopted an “affirmative” approach, which basically means taking the word of children who say they are the opposite gender (or a new, previously-unheard-of gender) and counselling them and prescribing drugs accordingly.

The UK-wide Cass report found that the whole field is bedevilled by “remarkably weak evidence”.

It said clinicians “have told us they are unable to determine with any certainty” which children genuinely have the lifelong mental condition known as gender dysphoria, and which are just going through a phase.

It also trashed one of the principle arguments of trans acvtivists: that transitioning children saves their lives.

"Tragically deaths by suicide in trans people of all ages continue to be above the national average, but there is no evidence that gender-affirmative treatments reduce this,” said the report, adding that “such evidence as is available suggests that these deaths are related to a range of other complex psychosocial factors and to mental illness”.

When the GB-based Gender Identity Development Service was set up in 1989 it dealt with about 10 children per year.

Now it gets upwards of 9,000 referrals per year.

Northern Ireland has its own service, Knowing Your Identity (KOI), based in south-east Belfast and set up in 2014.

From the outset it began prescribing drugs – hormones and hormone blockers – to children, but since 2020 it ceased offering these to new patients (and last month health minister Robin Swann formally ended the practice of giving them to children).

Besides formerly offering drugs, KOI provides “assessment and specialist psychological support”.

The Rainbow Project says it is “the main public health service in NI for trans and gender diverse people under 18 to access gender-affirming healthcare”.

The Belfast Trust said KOI is carrying on as normal following the Cass report, adding: “Belfast Trust acknowledge that the Cass report recommendations will influence the future direction of gender services.

“We look forward to working closely with the Department of Health to develop the model of care within Northern Ireland that meets the needs of the population.”

The Department of Health meanwhile sad it “notes” the Cass report, adding that “officials will meet with clinicians and stakeholders in the coming weeks to consider the review recommendations”.

Four different transgender organisations were contacted for their views on the Cass report – the Rainbow Project, Cara-Friend, TransgenderNI, and Trans Pride – but none responded.

DUP MLA Diane Dodds said it is now “abundantly clear” that “the provision of puberty blockers to children cannot be remotely described as ‘normal healthcare’... for it to have happened with so little evidence of their effectiveness or safety is shocking”.