Probably not. It is already ignoring Recommendation 23
Our Duty has a particular interest in Recommendation 23 of the Cass Review because we have very good reason to believe that it is only there because of our representations.
This is the recommendation that deals with what to do with 17-25 year-olds. At the Tavistock children who were 17 were often referred on to the adult gender clinics. The big problem with the adult clinics is that they exist. Keith Jordan raised the alarm about their affirmation-only approach way back in 2021. Since then, they seem only to have become worse. Adolescents are now being operated upon at the rate of one per day in the NHS. The majority of these operations are breast amputations but there are plenty of castrations, too. The Levy review into the adult clinics cannot happen soon enough, although we cannot have any confidence that it shall be objective, it might at least spark the very necessary conversation.
Recommendation 23 of the Cass Review (April 2024) states: “NHS England should establish followthrough services for 17-25-year-olds at each of the Regional Centres, either by extending the range of the regional children and young people’s service or through linked services, to ensure continuity of care and support at a potentially vulnerable stage in their journey. This will also allow clinical, and research follow up data to be collected.”
It is widely accepted that adolescence extends well into the twenties, and this is reflected in the NHS Long-Term Plan for mental health which advocates mental service provision for children and young persons to run through to age 25.
Shortly after the Cass Review’s publication Our Duty expressed concern that Recommendation 23 was being interpreted such that new 18 year-old patients would still be referred to the adult clinics while those 18 year-olds who were already in the child system would get the follow-on service. This had the curious effect of making the child services an attractive option for 17 year-olds because they would be saved from the far less circumspect adult services.
Now, however, the NHS Children and Young People’s Gender Service Draft Specification (March 2025) restricts services to age 18, with a limited extension to 18 years and 3 months for transitioning to adult care.
There is no mention of the follow-on service, no specification to implement recommendation 23. So is there any truth in the Government claims that the Cass Review will be implemented in full? It looks like it is being diluted already.
Given we need more and better protections for adolescents, the draft specification’s ignorance of Recommendation 23 is of grave concern.
The Cass Review emphasised that 17-25-year-olds require holistic care due to high rates of mental health issues, autism, and social pressures, with limited evidence supporting medical interventions like cross-sex hormones. By excluding this age group, the draft risks funneling young adults into adult “Gender Identity Clinics” which are geared up to facilitate the medical pathway.
It is Our Duty’s view that our adolescent children are at most danger from the adult clinics. Let us not forget that the majority of Adult Clinics sought to hide their data from the Cass Review. Parents who have managed to keep their children with transgender ideation safe from iatrogenic harm while under 18 risk losing their battle beyond that birthday. That cannot be right.
We advocate ensuring all those who are vulnerable receive appropriate care, that includes everyone up to age 25, but also older persons with known susceptibilities to transgender ideation, like autism. We also would like to see these services renamed “Ideation Clinics” so as to reflect the real issues and to downplay the role of ‘gender’ in an adolescent’s growing pains.
By ignoring Recommendation 23, the NHS risks neglecting 17-25-year-olds. To implement the recommendation in full, it must expand Children and Young Persons services to age 25, integrate follow-on care with adolescent mental health services, and prioritise desistance. The Cass Review was just the start of a move from ideological to evidence-based care, that which the review started needs to be carried through to its logical conclusion. If anything, the Cass Review opened the door to reality returning to the NHS, we now need another review that can walk straight through it, head held high, proud to be safeguarding our vulnerable youth.
References: https://ourduty.group/2025/04/20/nhs-children-and-young-peoples-gender-service-draft-specification-and-our-dutys-response/
