NHS England will roll out up to six new specialist regional centres by 2026 to provide tailored gender services for children and young people, based on recommendations in the Cass Review.

Following the publication of a comprehensive report by Dr Hilary Cass in April, the NHS has today set out how it will deliver transformed gender healthcare services for children and young people.

Two new NHS Children and Young People’s Gender Services, led by London’s Great Ormond Street Hospital (GOSH) and Alder Hey Children’s Hospital in Liverpool, have already opened in April.

The NHS will continue to appoint up to six additional new specialist regional centres by 2026 – with the next new service in Bristol becoming operational by November 2024 and plans to mobilise a service for the East of England over the course of 2024/25.

Each of the new services will have a nominated paediatrician or psychiatrist who has overall clinical responsibility for patient safety within the service as it establishes a fundamentally different clinical model built on the strongest possible evidence base.

Young people referred into the service will have their wider health and care needs considered and assessed holistically.

Following further advice from the Cass Review final report, the NHS has today confirmed after extensive engagement and public consultation, that all new referrals to specialist gender services must be made through mental health or paediatric services to ensure every child or young person has had a thorough assessment of need.

The documents published today also set out the scope for further research, in line with key recommendations from Dr Cass, to evaluate all approaches to inform the best possible patient care.

These plans also set out that, subject to academic approval, recruitment to a clinical trial into the potential benefits and harms of puberty suppressing hormones for children and young people is likely to commence in early 2025.

Alongside children and young people’s services, NHS England has also published plans for a review into adult gender services, following recommendations from Dr Cass.

This review will look at the effectiveness, appropriateness and stability of each current service, and will be led by Dr David Levy, Medical Director for Lancashire and South Cumbria ICB, who will be an independent chair, supported by a panel of expert clinicians, patients and representatives from Royal Colleges and professional bodies.

The findings of this review will inform an updated adult gender service specification which will then be subject to public consultation.

Professor James Palmer, NHS medical director for specialised commissioning, said: “The roll out of new specialist centres in every region across England will be central to improving and expanding NHS gender services for children and young people, to ensure that they receive evidence-based, responsive, holistic care – and the Cass Review is the backbone on which our implementation plan is based.

“It’s clear that our services for adults need focus too. The waiting times for care are too long and experiences of care are too variable. The review needs to address poor experience but also learn from good experiences of care. It’s vital we hear from patients and staff, some of whom have raised concerns to Dr Cass, and this review will be a further opportunity for them to be heard.

“There remains considerable work to do, but we are already making progress on a number of Dr Cass’ recommendations, and our plans published today set how we will establish services that provide the care that patients and their families need to thrive.”

Professor Sir Stephen Powis, NHS national medical director, said: “These plans set out in detail how we will establish a fundamentally different and safer model of care for children and young people. The work Dr Cass has undertaken has been invaluable in helping us shape the new service offer, and we have already begun our transformation of these services by opening two new regional centres this year.

“The plan published today now fully maps out this new service for children and young people and their families, which will be led by evidence and ongoing research to ensure their needs are fully met.”

Health and Social Care Secretary Wes Streeting said: “I am pleased to be working with NHS England to fully implement the recommendations from Dr Cass’s review, so that young people get the safe, holistic care and support they need. The unacceptable waiting times for gender services cause enormous distress to children and young people, at a crucial point in their lives.

“As well as rolling out new services, NHS England is setting up a clinical trial to establish the evidence on puberty blockers, because children’s healthcare should always be led by evidence.

“I want trans people in our country to feel safe, accepted, and able to live with freedom and dignity.”

Professor Sir Simon Wessely FRS, Chair of NHS England’s Gender Dysphoria Research Oversight Board, said:“The Cass Report identified major gaps in the evidence base for the management of gender dysphoria in children and young people. NHS England has created a Research Oversight Board to develop and manage a new programme of research to close these gaps, and ensure that young people and their families have the best information possible to support their informed choices. Taken together with the implementation plan which is published today these are important steps in transforming gender healthcare services for children and young people.”

Dr Hilary Cass said: “I am pleased that NHS England is planning to fully implement the recommendations of my Review and the next important step will be the most challenging – turning it into a reality.

“The vision of the Review – reflected in the implementation plan – is to increase available services for gender-questioning young people which take a holistic approach to care addressing the needs of each individual, and which put in place a full package of care which can be delivered as close to home as possible.

“Setting up a new collaborative of regional providers will also bring in leaders from professional societies, education, and research, to ensure these services continue to develop in line with evidence and best practice to support children and young people.”

Doctor Jeanette Dickson, Chair of the Academy of Medical Royal Colleges, said: “We welcome these important steps towards implementing the recommendations of the Cass Review because at the heart of this are thousands of children and young people in need of care. The sooner we can make sure they are treated by the most appropriate professional in a way that’s right for them, the better. NHS England has moved with admirable speed, but we must keep the pace up if we are to help these patients in a timely and fair way.”

Professor Mike Wang, Chair of the Association of Clinical Psychologists, said: “The Association of Clinical Psychologists UK welcomes the publication of the Cass Review implementation plan. We have been involved in the development of the implementation plan at every level and we are pleased that NHS England and the Academy of Medical Royal Colleges is relying on senior clinical psychologists to deliver training and to lead the new service hubs. We continue to support the recommendations of the Cass Review and welcome NHS England’s vigorous implementation project”.