We understand that discussion around this issue has been difficult in the medical community, in society, and indeed within the BMA itself. As clinicians, one of the most difficult parts of medicine is caring for patients with complex needs in a system that too commonly lacks the resources to provide them with adequate support.

The care of transgender and gender diverse children and young people in the UK is an egregious example, given both the underlying multiple needs of this patient cohort and the rising attacks on their very identity.

The Cass Review recommended a new care pathway focused on evidence, expertise, and patient care. While welcomed by some, others – including patients, their families, academics, scientists, and legal experts, and some of our members – have voiced concerns. The decision by NHS England in March this year, supported by the previous Government’s emergency regulation in June to ban the use of puberty blockers for transgender and gender-diverse young people, goes further than any recommendation in the Cass Review.

Dr Cass recommended that these agents should only be used under research conditions but did not call for an outright ban. Indeed, Dr Cass stated that 'for some, the best outcome will be transition', but the impact of the Government’s decision means that right now, today, there are those who could benefit from care who are being denied that option.

This approach has made an already meagre NHS service non-existent. I was pleased to learn this week, following the announcement of our evaluation, that NHS England will begin research trials into puberty blockers early next year. I hope that this will provide some reassurance to patients.

Irrespective of whether we’re discussing access to technology in the NHS, sexual and reproductive healthcare, or care for transgender people, the BMA believes that it is clinicians, patients, and families who should be at the centre of an evidence-based decision-making process about their health, not politicians. As a consultant in obstetrics and gynaecology, I have spent my career helping many patients – some very young – make sometimes difficult choices about their health and future. I know full well that our next generation, like everyone else, needs to be understood and supported.

At the BMA’s UK council meeting in July, councillors brought a motion which raised concerns about the rapid, but selective, implementation of the Cass Review’s recommendations. The motion was passed by council members and the BMA will now undertake a transparent, evidence-led evaluation of the issues raised with the Cass Review, the subsequent decisions taken by NHS England and the UK Government, and the state of transgender healthcare in the UK today.

I want to reassure you that the debate and vote at UK Council followed due process. Just as the Representative Body is elected by BMA members, so is BMA Council, and we are bound by the articles and bylaws and Standing Orders of Council. (1)

A paper that was shared with UK Council ahead of the debate was leaked to the press, along with the names of the motion proposers. Very soon after, members of our council were subjected to online harassment and abuse; some was so despicable, it cannot be repeated.  Several staff members also received abuse online.

Our Standing Orders allow for anonymity under several circumstances and, in my view, it is correct that council members, following such targeted harassment, should decide whether they wish their names to be published given the risk that it may invite further abuse. While names may be redacted, the number of council members who voted for each part of the motion will be shared with all BMA members after the minutes of the July meeting are approved at the next meeting of UK council, which is standard procedure. 

The motion passed by the BMA’s UK council criticises the Cass Review and the actions that have been implemented in its name. The critique it calls for, however, must begin from a point of neutrality and any evaluation must be evidence-led. Indeed, the Cass Review itself highlights that it is impossible to generate any definitive report in the absence of robust data and states it is 'critical that all future services form a learning environment' as the evidence base grows.

The scientific process necessarily invites debate and scrutiny. This is one of the reasons many of us became doctors, academics, and researchers. The idea that any review, even on such a sensitive topic, should not be critiqued, is, I believe, contrary to the very principles of that endeavour.

We are going to great lengths to ensure that the BMA Task and Finish Group taking on this important work will utilise the expertise of the professional body that has been the cornerstone of the association since its inception in 1832. The BMA has long been involved in discussions with both NHS England and the Department of Health and Social Care about improving care for transgender children and young people.

We have responded previously to consultations on care pathways and have been invited to respond to the upcoming UK Government consultation on puberty blockers. The Task and Finish Group will help the BMA as it considers these important issues.

Professor David Strain, chair of the BMA board of science, will chair the BMA Task and Finish Group. More information on its evaluation will be shared in due course and it is anticipated the group will report on progress at the end of the year.

Professor Phil Banfield

Chair, UK council

(1) Circumstances allowing for anonymity include when a member has a non-NHS employer and may not have 'trade union protection', or when a motion is sufficiently polarising and a vote in either direction may pose a threat to council member’s safety