An analysis of the Scottish Government GI healthcare team standards (SGHTS) in relation to the Cass recommendations
Authored by a GP and an educationalist
ScotPAG's response:
The ‘Gender identity healthcare: Adults and young people standards’ were published on 3rd September 2024, following the Cass Report (CR) of April 2024, which recommended an ‘holistic’ approach to children and young adults. CR clearly identified the need to involve and hold accountable a broad range of services and professions. In particular, Dr Cass stressed the importance of schools, social work services, and related professions in the process of assessment and intervention regarding children who stated they were ‘trans’. Instead, the SGHTS response to a GP who is a member of ScotPAG, exposed an extremely narrow interpretation of Cass which will inevitably, in our view, cause more harm to children and young adults.
The following points, highlighted by GPs who communicated with the Scottish Government, demonstrate our Scottish establishment’s inability to apply real critical analysis, alongside a failure to use best evidence.
Points to note about the standards:
• An FOI revealed that the draft standards were sent to over 20 charities supporting
gender identity and gender ideology, including LGBTYS, Mermaids and Stonewall
• GPs were not consulted. An astonishing fact, given they are repeatedly referred to in
the so-called ‘standards’
• GPs are not contracted to be involved in the prescribing and monitoring of hormone
therapy in 'gender identity' healthcare
• Consultation did not occur with educationalists, social workers, or professionals linked
to universal services
• In the Standards Definition Section, transgender is described as being an ‘umbrella
term for those whose gender identity differs or does not fully correspond with the sex
they are assigned at birth’. There is no good evidence for this description
• The standards refer to putative individuals receiving gender identity care as ‘people’.
This is a move away from established medical practice; it is advised that those in
receipt of medical care should be referred to as ‘patients', in keeping with normal
medical practice
• There is a lack of robust clinical evidence regarding the long-term adverse effects of
endocrine therapy. And yet GPs are being given equivocal advice regarding a clinical
decision making
• The Royal College of General Practitioners (RCGP) supports GPs who feel unable to
share or take on 'gender identity' care due to existing workload challenges. The RCGP
also advises that GPs should only work within the limits of their competencies
• Of the numbered standards, nearly all are incoherent and confused e.g. Standard
8.2: ‘organisations should have protocols in place for non-surgical, surgical and
pharmaceutical treatment’. It begs the questions: Which organisations? What
protocols?
• Clinicians must access the best possible evidence, but the standards have failed to
incorporate the Cass Review.
Regarding the Scottish Government’s response to the Cass review, the Public Health Minister Jenni Minto stated (03/09/24):
‘The Scottish Government have accepted the findings of the report in full and work has started to implement its recommendation’. Regarding SGIHATS she went on, ‘They were developed following an extensive public consultation as well as targeted consultation with people with lived experience, clinicians and a wide range of professional bodies.’
Jenni Minto is being impecunious with the truth, and frankly, we would argue, is misleading Parliament.
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