The Cass Review, an independent review of NHS England’s gender identity services for children and young people has been published. The Countess welcomes this comprehensive investigation into the gender identity service that provided treatment to children and adolescents who experienced distress relating to their bodies.
The review has ramifications for Ireland because the HSE used this service to treat 234 Irish children since 2009.
Among the most striking findings of the report are;
Since 2020, The Countess have been alerting politicians, HIQA (Health Information and Quality Authority), the Department of Health, TUSLA, the HSE (Health Service Executive) and the Department of Education about the dangers of puberty blockers and the medical and social transition of young people.
Our concerns have fallen on deaf ears. In response to a complaint about information published by TENI (Transgender Equality Network Ireland) regarding the use of puberty blockers, genital tucking, breast binding the Ombudsman for Children replied;
‘determining medical accuracy of information on a public website is not within our remit and as such we will not be examining this complaint further’.
If the Ombudsman for Children has no role to play in ‘determining the accuracy of information’ directed at children and teens who does? The Ombudsman’s lack of engagement was echoed by politicians, TUSLA, the HSE and the Departments of Health and Education.
The Cass Review has made untenable this refusal to engage with the problem.
State agencies may have avoided engaging with the evidence supplied by The Countess but they cannot refuse to engage with the evidence presented by The Cass Review because the system she reviewed is the system the Irish State engaged to care for Irish children.
Therefore, the Cass Review raises many questions that our politicians and State bodies must address. The areas of immediate concern are the HSE, private gender clinics, schools and the influence of lobby groups on policy and law.
The Cass Review came about following repeated whistleblower concerns about the treatment of children at London’s Tavistock clinic. The HSE invited the Tavistock to operate a satellite gender clinic for children, based in Crumlin hospital in 2009.
By 2019, clinicians in the Irish adult gender service were growing increasingly concerned about how the satellite service was run.
In 2022, Paul Moran, a consultant psychiatrist, criticised the operation of the clinic in an interview with the Irish Independent. Professor Moran pointed out that the NHS staff who worked in Ireland were ‘not registered [in Ireland], with no supervision, no governance, no audit. It was a completely irregular thing.”
The HSE continued to refer Irish children to the service after it was closed in 2022.
It appears that senior management in the HSE were ideologically wedded to the concept of ‘gender affirmative care’. The HSE did not listen to doctors in the Irish service who were concerned about the protocols employed by the Tavistock team.
The 2020 Programme for Government agreed by the Coalition stated that it would “create and implement a general health policy for trans people, based on a best-practice model for care, in line with WPATH” (World Professional Association of Transgender Healthcare). The WPATH model of care was also embraced by the HSE.
In March a massive trove of internal WPATH documentation and internal conversations was leaked. The contents of the leaked material should be a grave source of concerns regarding WPATH’s guidelines and it is clear any public policy that has relied on WPATH guidelines must be revised immediately.
The Cass Review demonstrates what happens when policy is led by activists not evidence. The HSE has many questions to answer and must confirm that it will implement the recommendations of the Cass Review as a matter of urgency.
The Cass Review draws a clear line in the sand that any national health service would be foolish to cross. But what about private clinics? They are not legally obliged to adhere to the Cass Review findings.
At least two private ‘gender care’ providers operate in Ireland; Gender Plus and Gendercare. Gender Plus is run by former Tavistock psychologist Aidan Kelly and describes its work as ‘guided by WPATH (World Professional Association for Transgender Health) Standards of Care and NHS Service Specifications for Gender Services’.
Gendercare – run by former TENI employee, Vanessa Lacey – is an ‘Irish based gender-identity consultancy, that provides various transgender related services throughout the globe’. Lacey has been a member of both WPATH and its European offshoot EPATH (European Professional Association for Transgender Healthcare).
Aidan Kelly has disputed many of the Cass Review findings and stated that a German review had found that puberty blockers were safe and effective. He claimed that changing the model of care employed by the Tavistock left them “out of step with the rest of the world”.
This is untrue. Finland, Norway, Sweden, France and Denmark have all restricted or banned the use of puberty blockers in the treatment of gender-related distress in children because, as the Cass review makes plain, there is no reliable, long-term evidence base to support their use.
There is nothing preventing private Irish gender clinics engaging the services of endocrinologists to prescribe puberty blockers/cross sex hormones or signpost families to services abroad that provide hormone and surgical ‘affirmation’ treatments, including double mastectomy for girls and castration for boys.
The Cass Review explicitly recommended that steps must be taken to reduce access to private prescriptions for puberty blockers or hormones and recommended that GPs and other clinicians do not get involved in shared care with private providers.
The Health Information and Equality Authority (HIQA) the body that sets national standards and guidance for the delivery of health and social care services must issue a statement on the operation of private gender clinics in Ireland.
The review also highlighted the responsibility of pharmacists to ensure the suitability and safety of what they’re dispensing and reminded them that they could be criminally liable.
The Cass Review suggests that the England’s Department of Health should outlaw the provision of puberty blockers from clinicians and pharmacies that are not licensed or from doctors that are not licensed in the UK. A similar ban must be applied in Ireland.
No child is born in the wrong body. But if an adult, particularly a teacher, tells a child that they can be, then that fiction suddenly becomes fact.
Teaching children that they have a gender identity (believing one is male, female, neither or both) and that this identity may or may not match their sexed body is indefensible. Teachers would not affirm a student suffering with anorexia by agreeing that they are overweight. The gender identity lie is promoted to children in schools in two ways; by teaching children that everyone has a gender identity and via the process of ‘social transition’.
In March 2023, Norma Foley sanctioned teaching children that gender identity is a fact by including the term in the revised Junior Certificate SPHE (Social Personal Health Education) curriculum. Its inclusion was resisted by many.
When the NCCA (National Council for Curriculum and Assessment) invited the public to comment on the contents of the proposed SPHE curriculum many parents and groups, including The Countess, were disturbed by the ideological tone and the inaccuracies of the content. The Countess produced a toolkit to help parents make their concerns known to the NCCA. In a subsequent report outlining the content of the 4,000 public submissions it characterised perspectives critical of the draft curriculum as being
‘so similar, both in substance and in wording, as to suggest that the responses were based on a petition-style communication emanating from a small number of groups’.
This is a disturbing characterisation of any grass-roots campaign that informs parents about changes to public policy. What would have constituted a legitimate method of expressing concerns about the curriculum?
Although the NCCA tried to delegitimise parents’ concerns they had to listen to them. The most extreme elements of gender identity theory were removed but in a sleight of hand the Department deliberately left gender identity listed in learning outcome 1.4 as ‘one of the factors and influences that shape a young person’s self-identity’.
By including ‘gender identity’ in the list of influences that shape a young person’s identity the Department of Education enabled resource providers to interpret gender identity however they wished. Some educational textbook publishers have taken a cautious approach while others are stating that humans can be ‘male, female, neither or both’, include the Genderbread Person infographic in their textbooks and suggest that sex is not binary but on a spectrum.
The Primary school curriculum does not explicitly tell children gender identity is a fact but activist teachers, patrons, third party providers and resources funded by other Government agencies do.
Belong To, an LGBTQI youth lobby group, influenced primary school SPHE resources including the Learn Together Programme and the Busy Bodies booklet, produced by the HSE, Healthy Ireland and Sexual Health Ireland.
Belong To were instrumental in choosing language used in the Busy Bodies booklet. At a meeting to discuss the content of Busy Bodies they commented that they were “Trying to keep is [sic] positive and not scary”. The statements “we all have a gender identity” and “gender identity is how we think of ourselves as a boy, a girl, neither or both” were suggested by Belong To.
Gender identity is promoted in schools is via ‘social transition’. This involves schools enabling students to change their names, pronouns, clothing and bathroom use. The Cass Review ‘showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence’.
The review did find that “those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway.”
The HSE and schools must take these findings seriously. Considering the lack of evidence for socially transitioning children Minister Foley has a moral and legal responsibility to issue a circular to all primary and secondary schools instructing principals to refuse any further request to facilitate social transition.
The Minister must shut off the schools-to-clinic pipeline and amend the curriculum to acknowledge that having a ‘gender identity’ is a belief not a fact. Schools that have already facilitated a student’s social transition must consider how best to ensure the welfare of that child because there is no evidence that social transition will alleviate their distress.
The INTO, ASTI and TUI all contain cohorts of activist teachers that aggressively promote gender identity in primary and secondary schools. The INTO produced a now infamous video that states boys can change into girls and girls can change into boys. This is obviously factually incorrect.
The video is no longer available on the INTO website but was used to teach an unknown number of primary school teachers how to facilitate social transition.
All teaching unions have an obligation to protect their members from civil proceedings that may rely on the finding of the Cass Review. Teachers have been emotionally manipulated into teaching gender identity as fact and enable social transition by calls to be ‘kind’ and ‘progressive’.
The Countess has spoken to teachers who saw the obvious harms in this behaviour but were ignored when they tried to raise the issue in schools. Teachers who wanted to speak out were afraid that their union would not back them for telling the truth.
The publication of the Cass Review is an opportunity for teaching unions to call a halt to their unquestioning promotion of gender identity. They must put the interests of their members and children before the needs of activists.
Why did society turn a blind eye to this blatant disregard for children’s safety and wellbeing? Much as was the case with teachers most people who participated in the gender identity fallacy did so because their decency was exploited. However, there are some individuals and groups who cannot be permitted to take advantage of the excuse that they were ignorant rather than deliberate in actions.
Gender identity has been propagated at every level of government via the 2019 – 2021 LGBTI inclusion strategy. The strategy has little to do with promoting the welfare of same sex attracted people and everything to do with embedding gender identity theory into public policy and law.
NGOs have no authority to determine public policy but when Government unquestioningly defers to this sector for the content of what will become national strategies we end up in a situation where individuals with no appropriate or relevant qualifications are driving health and education practice to the detriment of children’s welfare.
These organisations, which sought to cancel, disenfranchise and demonise people, particularly women, who raised concerns about what was happening to children’s and women’s rights as a result of embedding gender identity into policy and law, have serious questions to answer.
There is a staggering absence of curiosity among academics, medics, NGOs and most journalists about why children have come to believe they could be born in the wrong body. People who are curious by profession show little spirit of enquiry about why so many teenage girls are socially transitioning to male or non-binary identities.
The Cass Review shows that in 2018/2019 the number of girls identifying out of their bodies so far exceeded that of boys that the NHS gender service stopped recording the sex of referrals. The exponential increase in the number of natal girls wanting to abandon female embodiment coinciding with the ubiquitous availability of porn and the rise of social media doesn’t strike the professionally curious as worthy of investigation.
Autism charities such as AsIAm have shown little interest in why upwards of 90% of those presenting to the Irish adult gender service in Loughlinstown are diagnosed with autism.
Anyone who questions why young people on the autism spectrum would seek to ‘change sex’ runs the risk of being called ablest and accused of seeking to deny people with autism ‘agency’.
Facilitating people with autism to do themselves irreversible damage is not advancing their human rights. If a similar percentage of all patients presenting to a diabetes clinic also had autism there would be a stampede to research the underlying reasons why.
Children and vulnerable adults cannot give informed consent to social and medical interventions that they do not have the capacity to understand. In the wake of the publication of the Cass Review the Government must curb the open-door policy it operates for NGO and civil society organisations that peddle this lie.
All policy and law must be based on independent, peer-reviewed evidence and not on agreements made with vested interests.
The Irish State is no stranger to scandals. Political, child abuse, medical. We are now facing one that encompasses all three.
If the Government fails to take the Cass Review seriously the taxpayer will bear the cost of a deluge of legal claims for harm done to children in decades to come.
Gender identity ideology is a many headed hydra, it will be insufficient to address one area alone. The surest way to protect children and the taxpayer is by telling the truth. The truth is no child is born in the wrong body and our Government must find the courage to say it.
RESISTING IDEOLOGY CONFERENCE: SATURDAY 27TH APRIL 2024.
In light of the Cass review, The Countess is hosting a major conference in the RDS on Saturday April 27th, exploring the impact of gender ideology on Irish society across legislation, policy, education, culture, and sport.
This national event will bring together ordinary women and men from across Ireland for discussion, debate, and insights from activists, thought leaders, and experts across key subject areas. Join the fight for reality, for freedom of speech, for evidence-based healthcare, for the future of our society.
Tickets at: https://www.tickettailor.com/events/thecountessadvocacy/1195625