Debate contribution: Gender Identity Services: Cass Review of Provision in Northern Ireland

Debate contribution by Mr Mike Nesbitt on 8 September 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

8 September 2025

Type

Debate contribution (made as a minister)

Business

Question for Urgent Oral Answer

Heading

Gender Identity Services: Cass Review of Provision in Northern Ireland

Assembly identifier

Official Report component 5068497

Read the official Assembly record

Text

When I spoke to Dr Cass, I asked her whether she was prepared to come to Belfast in order to conduct a short, sharp quality assurance review of our gender identity service. She has agreed to come with a small team of independent experts to do that in the coming weeks.

I can confirm that the service will not be an affirming one. For the avoidance of doubt, when the Member says "affirming", I think that he means that, if a young person goes to the service and says, "I believe that I am the wrong gender", the service will immediately move to change their gender through surgery. That will not happen. Nobody will be coerced. Why am I bringing in Dr Cass? It is because I heard people, including Members of the House and specifically Mr Buckley, claim or make statements in media commentary that implied that it is an affirming service. Indeed, he did so on the radio in a debate that included Alexa Moore from the Rainbow Project. Alexa made it clear that it is not an affirming service. She said that that is what they wanted, but they did not get it. In order to tackle the misinformation from people such as Mr Buckley, I decided that the best way to assure ourselves that the gender identity service that we offer is Cass-compliant is to bring in an independent expert to review it, and who better as the independent expert than Dr Cass?

We have had ongoing consultation with stakeholders on the design of our service but not with Dr Cass. That was my call. For completeness, I will share all the information. Dr Cass is coming with three other experts. Camilla Kingdon is a paediatrician and the immediate past president of her royal college. She is chair of the National Provider Network, the group that coordinates clinical approaches, education, audit and research across the new centres. Julie Alderson is a psychologist and the clinical director of the new Bristol service. She has also been a key figure in training our new staff on the shared holistic assessment framework that is used across all the new centres. By the way, when I say, "new centres", the Member will be aware that Wes Streeting, the Secretary of State, closed the gender identity service at Tavistock and is now creating six new regional centres in England. Finally, Judith Ellis is a nurse by background. She chaired the original multi-professional review group, which ensured that children and young people who were referred for puberty blockers had been through the appropriate consent, safeguarding and other processes. She has been a chief nurse at the Great Ormond Street Hospital, has had numerous other roles and has a lot of experience in education, quality assurance and setting standards.

The answer to that is no.

Just for the record, the investment is £806,000, not the figure that the Member mentioned. That is for the service going forward. Very little has changed except that, previously, we had two services: a children's service known as KOI — Knowing Our Identity — and an adult service. The Member is well versed in health and social care provision, and he will be aware that it is far from unique for a move from one to the other not to mean being in one on a Sunday night and in the other on Monday morning. You hit a cliff edge and go back on a very long waiting list. That is why we decided that we needed the single lifetime service. The big changes are the ones that are Cass-compliant, which put a greater emphasis on psychological and psychiatric interventions. It is my understanding that, since the service began in 2014 — the money for it was signed off in 2013 — very few people have been referred to England for surgery. Very few.

I note the Member's comments. The previous Government in London, in which Victoria Atkins was the Secretary of State for Health and Social Care, wanted to bring in a temporary ban on puberty blockers. Eventually, the Executive joined in, extending that ban to Northern Ireland and, as the Member knows, that is now an indefinite ban, pending the results of clinical trials on puberty blockers. When I spoke to some of the families and the young people who wanted access to our gender identity service — Know Our Identity — it became clear that the wait was way too long. In fact, they were saying that there is not even a waiting list: the service was simply not taking new referrals because it was not resourced. The consequence of that was that loving parents, who wanted to do their best for their children, were turning to private providers. Who in the House, as a father or a mother, might not think that they would do the same thing? One example that I was given — I think that I am right in this case — was of a private provider who was Spanish, based in Romania and prescribing puberty blockers out of Singapore. Where was the safety or regulation in that? However, because I was being told that the only reason why people are going to the private providers is because our service exists only in name for young people who want to get a new referral to it, I decided that we must find the money to make the service work.

908 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 13:02 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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