Untying the Welsh Gender Knot: Will the Welsh Government Follow Cass?
By Ben Sears
Wales is in a tangled mess with gender identity. The publication of the Cass Review in April is tying the Welsh Government and NHS Wales in ever-tighter knots as they try to reconcile their ideological and activist-driven policies and treatment pathway with the rigorous and dispassionate findings of Cass.
In May, Health Minister, Eluned Morgan, confirmed in the Senedd (Welsh Parliament) that:
NHS Wales has also been working with NHS England, as part of the transformation programme for gender services, to ensure we are aligned to the Cass recommendations, as part of the changes NHS England is making to gender identity services for children and young people.
Despite this, the Welsh Government (WG) has refused to review their LGBTQ Action Plan and remains committed to its implementation despite many of the Action Plan’s recommendations contradicting those of the Cass Review.
The Action Plan’s philosophy is one “underpinned by the human rights-based approach set out by the UN High Commissioner for Human Rights” (WG, 2023) and its tone is one of affirmation and celebration. It nods to providing evidence-based care without explicitly identifying which evidence bases might be used. As highlighted in the WPATH Files’ WPATH in the UK report, however, NHS Wales references WPATH Standards of Care in their adult Gender Identity Service for Adults (Non-surgical)commissioning policy. Though children’s services still deferred to England at the time the commissioning policy was written, the Action Plan commits to the development of a new and separate Welsh Gender Identity Service. So, which will these new services align with—Cass or WPATH?
Where Cass highlights the poor safety and efficacy of current treatments for gender-questioning children and young people and recommends, for example, that puberty blockers and masculinising and feminising hormones should not be routinely prescribed for those under the age of eighteen, the LGBTQ Action Plan, while again remaining vague on the children’s pathway, commits to “Further reduce waiting times for the Welsh Gender Service and Local gender teams. Enable GPs to initiate hormone therapy as part of the adult pathway…” (WG, 2023). There is also strong pressure from the Welsh Government’s Independent LGBTQ+ Expert Paneland associated activist groups to “promote a de-pathologised and human rights-based approach to care”, emphasising that “treatment protocols should move away from the traditional psychiatric approach…” which “…can involve intrusive and degrading questioning” (WG, 2021). This again puts it in conflict with the Cass Review, which says that “For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.” (Cass, 2024).
What this all shows is that until now, the Welsh Government and NHS Wales have been promoting an affirmative model of care based on the discredited Dutch protocol and informed by the disgraced WPATH. If, as publicly committed to, they are to now follow the Cass Review’s recommendations, they will have to unpick the knot of ideologically-driven policies, which have tied up education as well as healthcare, and radically remodel their approach to gender identity services and the topic of gender identity more broadly. As well as being a logistical nightmare, untangling this mess will be a political one for Welsh Labour too.
References
Cass, H. (2024). Final Report – Cass Review. [online] cass.independent-review.uk. Available at: https://cass.independent-review.uk/home/publications/final-report/
Welsh Government (WG). (2023). LGBTQ Action Plan for Wales. [online] Available at: https://www.gov.wales/lgbtq-action-plan-wales
Welsh Government (WG). (2021). A report to Welsh Government outlining recommendations for furthering LGBTQ+ equality in Wales. [online] Available at: https://www.gov.wales/sites/default/files/consultations/2021-07/recommendations-of-the-independent-lgbtq+-expert-panel_0.pdf
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