1 British Journal of Healthcare Management | 2022 | https://doi.org/10.12968/bjhc.2022.0089 COMMENT © 2022 MA Healthcare Ltd There is only one gender identity development service in the NHS, which is run by the Tavistock and Portman NHS Foundation Trust, with clinics in London and Leeds. This service has been subject to controversy for various reasons, including the prescription of puberty‑inhibiting drugs to adolescents. Puberty inhibitors can delay some of the changes associated with puberty by blocking sex hormones, and are used in adolescents who do not identify with the gender they were assigned at birth to prevent or reduce the gender dysphoria that can be exacerbated by puberty. Although the gender identity development service describes them as ‘reversible’, the long‑term impact of puberty inhibitors on brain development and psychological health is not yet fully known (NHS, 2020). This, along with other issues identifed in the gender identity development service, including its serious lack of capacity, has led to a review of the service, led by Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health. An interim report was published in February 2022, with the full report due later in the year (Cass, 2022). Findings of the interim Cass report Former staff members at the NHS gender identity development service clinic had raised concerns that teenagers who want to transition to a different gender have been given puberty inhibitors without adequate assessment. The service has prescribed these drugs to children from the age of 12 years, with the Court of Appeal upholding the ability of the gender identity development service to prescribe them to those aged under 16 years, as long as they are deemed capable of giving consent. This ruling, made in 2021, overturned a previous ruling against prescribing puberty inhibitors to those aged under 16 years in 2020 (Cass, 2022). The Department of Health and Social Care has been considering changing the law to allow the independent Cass review to access an NHS database of young people who have received treatment at the gender identity development service. One of the aims of this is to investigate patients’ experiences of their care at the service and to understand if any later had regrets regarding the treatment they received, particularly puberty inhibitors (Crawford, 2022). This change to the law is being sought because the review found a lack of expert agreement around what constitutes gender dysphoria, with health practitioners at the gender identity development service reporting feeling ‘under pressure to adopt an unquestioning affrmative approach’ to adolescents who felt that their gender may be different to what was assigned to them at birth (Cass, 2022). This non‑exploratory approach does not align with standard processes of clinical assessment and diagnosis (Cass, 2022), and may also prevent other factors that are known to be associated with gender dysphoria from being addressed, including poor mental health, autism and certain family dynamics (Robinson et al, 2014). Cass (2022) noted that one of the main reasons for this approach was the long waiting list for the gender identity development service, as the delay in accessing care meant that many patients had already undergone a considerable level of social gender transition. This approach to care meant that there was a lack of open discussion about patients’ needs. Therefore, some service users may have received puberty inhibitors without proper discussion or assessment (Cass, 2022). How to cite this article: McIntosh B, Koseda E. The interim report of the Cass review into the NHS gender identity development service: a discussion. British Journal of Healthcare Management. 2022. https://doi. org/10.12968/bjhc.2022.0089 The interim report of the Cass review into the NHS gender identity development service: a discussion Professor Bryan McIntosh and Ellie Koseda provide an overview of the review into the NHS’s only gender identity development service, led by Dr Hilary Cass, following the publication of the interim report in February 2022. Key issues in this complex and developing feld are discussed. Bryan McIntosh 1 Ellie Koseda 2 Author details can be found at the end of this article Correspondence to: Bryan McIntosh; bryan.mcintosh@brunel. ac.uk