The Rainbow Project’s Statement on the Cass Review

The Rainbow Project is concerned by a number of elements contained in the Cass Report released this week on care for transgender children and adolescents. We’re currently taking the time to read through it and digest all its implications for care in England and any ramifications it might have across the UK and Ireland. 

Cass makes a number of positive suggestions which we would support, particularly around moving away from a centralised model of care to more decentralised regional care networks, providing holistic support to children and young people exploring their gender, and having a wider range of healthcare professionals who are competent in working with trans children and young people. We also support the call for further research on healthcare outcomes – provided it is collaborative, ethical and consensual – however this should not be used to deny access to the care that we know generates positive outcomes for trans children and young people. 

However, on the whole, we share the concerns of many in our communities regarding the impact implementing the recommendations of this report will have on access to puberty blockers and Hormone Replacement Therapy (HRT) for trans young people. The ‘watchful waiting’ approach, attempting to explain away trans identity by exploring every other possibility – whether it be mental health, neurodivergence, experiences of sexual abuse, or anything else – without providing access to care, has not worked in Northern Ireland and it will not work in England.  

The refusal to accept a vast swathe of research demonstrating the clear positive outcomes for thousands of trans young people who have accessed medical transition demonstrates a lack of willingness to engage meaningfully with the fact that this transition, for so many people, is hugely beneficial to their quality of life.  

This review appears to approach the idea of transition as a last resort, an outcome that should be avoided for children and young people at all costs. While we absolutely accept that not every young person who is exploring their gender and expression will come to identify as trans, that is no reason to deny care to those who will and do. Services should be designed for those who need their care, rather than with the aim of preventing them from accessing it.  

While the Cass Review was specifically intended to apply in England, we know it will have implications for care in Northern Ireland, and indeed across the UK and Ireland. It is our continued view that the Gender Identity Service Pathway Review, commissioned by the Health Minister remains the best way to review and reform services locally. We in Northern Ireland have separate gender identity services, which have operated diffently from those in England, so any notion to attempt implementation of the Cass Review in Northern Ireland would be folly. 

The focus of reviews of gender affirming care should be on reducing rapidly spiralling waiting times, moving away from a stigmatising and pathologising view of trans identity, and providing timely and accessible care to the hundreds of individuals on the waiting list stretching over 6 years. 


For comment or media enquiries, please contact our Policy, Campaigns and Communications Manager Alexa Moore at

Share this page