In March 2025, NHS England released the Draft Service Specification for the NHS Children and Young People’s Gender Service (Version 5), outlining the framework for providing care to children and young people experiencing gender incongruence. This document, informed by the Cass Review (April 2024), proposes a holistic, multi-disciplinary approach to support this vulnerable cohort, emphasising psychosocial interventions, robust safeguarding, and limited use of medical interventions like puberty-suppressing hormones due to insufficient evidence of their safety and efficacy.
Our Duty, a parent-led organisation advocating for evidence-based, non-medical approaches to transgender ideation, has submitted a detailed response to the NHS consultation. Founded in 2018, Our Duty represents over 3,000 parents across 30+ countries, prioritising the safeguarding of children and adolescents from potential harms associated with medical interventions. Their submission critiques the draft specification, raising critical concerns about language, safeguarding, age limits, and the risk of ideological bias, while proposing actionable improvements to align with the Cass Review’s recommendations.
Key Documents
We are making both the NHS Draft Service Specification and Our Duty’s response available for public review:
This 20-page document details the proposed service model, including holistic assessments, referral pathways, and safeguarding protocols for children and young people up to age 18.
This 18-page submission outlines Our Duty’s concerns, including the need to rename the service “Ideation Clinics,” extend care to age 25, strengthen safeguarding against social transition and unregulated medications, and prioritise desistance from transgender ideation.
Why This Matters
The NHS’s Gender Service specification will shape the care provided to a growing number of children and adolescents experiencing distress related to their gender identity. With referrals rising significantly (from 0.14 per 10,000 in 2011 to 4.4 per 10,000 in 2021), and a notable increase among adolescent females, the stakes are high. The Cass Review highlighted the complexity of this cohort, noting high rates of mental health issues, neurodevelopmental conditions, and social influences like peer pressure or online grooming.
Our Duty argues that the draft specification, while a step forward, falls short in critical areas:
- Service Name: The term “Gender Service” risks pathologising normal developmental exploration. “Ideation Clinics” would better reflect the psychological focus.
- Age Range: Limiting services to age 18 ignores the Cass Review’s call for care up to 25, risking care disruptions for adolescents with prolonged neurodevelopmental needs.
- Language: Terms like “gender incongruence” and “gender identity” lack scientific grounding and may entrench ideological beliefs. “Transgender ideation” is proposed as a neutral alternative.
- Safeguarding: Weak protocols on social transition, unregulated medications, and online influences leave children vulnerable to harm.
- Medical Interventions: References to puberty blockers and hormones are concerning given limited evidence of benefit (NICE, 2020). Desistance should be the primary goal.
- Support for Desisters/Detransitioners: The specification overlooks those who resolve ideation or regret medical interventions, particularly females and neurodiverse individuals.
Our Duty’s Call to Action
Our Duty urges the NHS to fully align with the Cass Review by prioritising prevention, desistance, and evidence-based care. They emphasise the need for robust data collection to understand the causes of transgender ideation, such as social contagion or the “school-to-clinic” pipeline, and to support longitudinal studies on outcomes like desistance and detransition. They also call for staff training free from ideological bias and governance to prevent the influence of gender identity ideology.
