statement on the NHS Cass Report

The Cass Report is the final report of Dr. Hilary Cass’s review of trans healthcare for children and young people in the NHS. The report is unequivocally transphobic, rejecting the agency and self-determination of trans people. We at the Feminist Library stand in solidarity with trans people in the fight for their healthcare, and see the struggle as part of wider Feminist struggles for bodily autonomy and healthcare equality. We echo the statements of @transationbloc and @thedykeproject in our position. Below is a statement written by a volunteer on the report and public response to it.


Cass Report – A single trans woman responds.

The release of the Cass report was expected, but also reached further than many people feared. More surprising was the response; seeing queers, trans people, allies and charities respond with fear to criticise a document that hid under the vanilla modernisation of children’s health service in amongst a backdrop of transphobic drivel and denialism.

Trans healthcare is of course upsetting and filled with practitioners who do not understand trans people. No one has said this louder than the children who have received it and the adults who never got off the waiting list. It also remains one of the only avenues many kids have to help with the alienation they feel within their body. It’s also no different from many other services in the healthcare systems that deal with women’s health concerns.

The report mentions this of course, but not for reasons allies would like to imagine. Cass has rejected national and international published research on care for trans children. However earnest your intentions, to believe that Cass’s report holds any merit – with its insertion of her own ideological speculation and assumption, its insistence these do not form each other – is to be asleep at the wheel. It’s to deny the history of trans exclusion in healthcare, and the use of the liberal woman to deliver the destruction of people’s rights.

If we did bear both these things in mind, the report amounts to little more than the stripping of existing services and asking it to be replaced with an infinitely complex system of checks and balances, pre requirement diagnoses which themselves have long waitlists and histories of trans trauma, rigorous middle managers and various forms of means testing. We could sum all these up as points of failure, which are intended to stall a child on their path of transition. This has the same material impact as an ideological ban to those on the right, but with the important difference being a veneer of technocracy to those in the centre.

While white children of middle class liberal parents will be able to work this system like they do a SENCO coordinator or exam remarking for their wronged child, a black trans girl of a working single mum in Manchester is never going to survive such a system, much like they do not survive many of the systems which are designed along these lines. You could say these institutional barriers exist in the current system already, you’d be right, but these reforms only go on to entrench that inequality. This form of middle management, means testing, intends to deter those from applying; to exploit and punish those who are successful when they do.

Historically, as a queer community, we will consciously and subconsciously marginalise the voices of trans women, especially black and brown trans women. It’s no surprise the first public responses of the Cass report are reflective of this and as such suffer for it. Trans women are marginalised and often look inwards, with mutual aid solutions or self-insulation, no different from cis women in response to everyday patriarchy. The effectiveness of these actions (and how insular they are) is influenced by class and race. This will not protect them from the ramifications of this report, however. Concessions here will not only impact trans women’s direct access to hormones, but their access to all healthcare, equal treatment and having a medical consciousness of their existence realised and defended. Concessions here will be excitedly repeated in other areas of trans and cis women’s autonomy, be it abortion, civil rights or women’s health. It’s important we remain outward-looking and intersectional, such as the self-described transfeminist group Trans Action Block.


Post-script for the trans:

some trans people might read this and reflexively go “this is the importance of DIY paths”, they would be right in comforting themselves like this, it’s important to many and optimal in nearly all cases. I would however warn that the elimination of trans people, or the blocking of it has further reaching impacts than simply accessing hormones. You will need breast and prostate scans, you will need a colonoscopy or rectal exam at some point in your life, all these restrictions now could impact your access to the rest of your healthcare; they’re intended to.

This “polite exclusion” outlined in this report gives oxygen to those gate keepers who might politely refuse to prescribe medications, or perform examinations for non-trans medical care because the system does not acknowledge you as trans unless you’ve completed their hunger games of transition, viewing anything else as perversion. I’m sure many have experienced this polite exclusion already, this report only expands on it, not only for children, but for adults up to 25 and a proposal for a full review of all trans healthcare and review of private access GP’s which leads to drug reclassifications.

Again, this will be navigable for a white middle class professional in a major city, but infinitely harder for the brown hospitality worker in Dudley. While community and mutual aid is important, essential and lifesaving, we must continue to challenge the systems of the general society we exist within.