NHS England has pledged to create a ‘training curriculum and competencies framework’ around gender identity for children and young people for staff working across primary, secondary and community care.
The commitment comes after consultant paediatrician Dr Hilary Cass published her final report as part of a four-year independent review of gender identity services for children and young people.
The review, published on Wednesday, sets out 32 recommendations including for further research on the topic and for ‘gaps in professional training programmes’ to be identified and for a ‘suite of training materials’ to be developed.
Led by Dr Cass – who is also former president of the Royal College of Paediatrics and Child Health – the review was commissioned by NHS England in 2020.
Within the 388-page document, Dr Cass said the evidence base underpinning medical and non-medical interventions in this clinical area ‘must be improved’.
She recommended a ‘full programme of research be established’, focusing on the ‘characteristics, interventions and outcomes of every young person presenting to the NHS gender services’.
In addition, Dr Cass said there were ‘conflicting views about the clinical approach, with expectation at times being far from usual clinical practice’.
‘This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services,’ added the report.
Within her recommendations, Dr Cass also urged NHS England to commission professional bodies to ‘develop a competency framework’, ‘identify gaps in professional training programmes’ and ‘develop a suite of training materials to supplement professional competencies, appropriate to their clinical field and level’.
The report said: ‘The first step for the NHS is to expand capacity, offer wider interventions, upskill the broader workforce, take an individualised, personal approach to care, and put in place the mechanisms to collect the data needed for quality improvement and research.
‘Expanding capacity at all levels of the system will not only allow for more timely care and space to explore, but also free-up the specialist services for those who need them most.’
Dr Cass also said she supports NHS England’s proposal for all referrals from specialist regional hubs to now come via secondary care.
The Cass Review followed concerns about the care at the Gender Identity Development Service (GIDs) at the Tavistock and Portman NHS Foundation Trust and a sharp increase in the number of children and young people being referred.
The GIDs closed last month and NHS England has said it is now creating eight regional centres, based within children’s hospitals.
The review states that new regional centres ‘will need a broad multi-professional workforce’, including clinical nurse specialists, with an ‘appropriate skill mix to support both individuals for whom medical intervention is clinically indicated and those for whom it is not’.
In a response letter also published yesterday, NHS England agreed to ‘commission the required professional training curriculum and competencies framework, not just for staff working in the new gender services but also for clinicians working in secondary care, primary and community care’.
An NHS England spokesperson added: ‘We will set out a full implementation plan following careful consideration of this final report and its recommendations, and the NHS is also bringing forward its systemic review of adult gender services.’
The School and Public Health Nurses Association (SAPHNA), that spoke with Dr Cass as part of the review, told Nursing in Practice it was hoping to be included as part of the recommended ‘consortium’ of experts to help inform training, materials and additional expertise within this area.
Responding to the review, SAPHNA chief executive Sharon White, said: ‘SAPHNA fully support the robust and sensitive report with a much-needed primary focus on expanding services across the country; there are so many children and young people awaiting assessment, some for years; this must urgently change.
‘The waits and uncertainty are causing additional emotional distress affecting their schooling, attendance, attainment, socialising, confidence, resulting in bullying, stigmatisation, and much more.’
Dr Crystal Oldman, chief executive of the QNI, said the review ‘highlights many complex issues in the treatment and care of children’.
‘Community nurses have a vital role to play in the physical, mental and emotional health of children and young people, but services have suffered from a lack of funding and are overstretched,’ she added, while pointing to the recently launched ‘School Nurse for Every School’ campaign.
Paul Carruthers is a nurse consultant who heads up the hormone clinic at Gender Plus. He has worked as a clinical nurse specialist in NHS paediatric services for almost twenty years and worked as a key member of the GIDS Endocrine team from 2015 to 2023.
Mr Carruthers told Nursing in Practice that improved training and representation of transgender people in nursing is key to enriching professional understanding of how best to support trans individuals.
‘Training on this topic needs to be embedded into the curriculum, not just as a one- or two-hour slot but as annual equality, diversity and inclusion training which is regularly updated,’ he added.
‘We also need better training on sexuality, not just gender identity, because some nurses report not knowing how to speak about sexuality, it’s not their fault, but that training needs to be updated.
‘Trans people are an incredibly marginalised community particularly in the current political climate, they are also no different from cis people in that they deserve equal access to healthcare, being trans is just as good an outcome as being cis.’
While he said he endorsed the reviews’ ‘promotion of a holistic approach’ to this clinical area, he said he was concerned about ‘a cis bias’.
‘There is a real need to listen to lived experiences and case studies, because this can help deliver really rich training, especially as representation really matters for understanding,’ he added.
