The Cass report, children, and the Church of England

Ian Paul is a theologian, author, and speaker. He serves as an Adjunct Professor at Fuller Theological Seminary, an Associate Minister at St Nic's, Nottingham, and is Managing Editor at Grove Books. Additionally, he's a member of the General Synod and a former governor of three schools.

Ian offers his perspective and analysis of the Cass Review, with particular reflection on the implications for CofE schools. In the upcoming weeks, ACT will release its own reaction, focusing on how all Christian educators and staff can respond to the report.

This has been reproduced with kind permission. It was initially published here

Dr Hilary Cass has delivered her final report offering an independent review of gender identity services for children and young people. The report is online, and is long and complex (not surprisingly) at 232 pages for the main body of the report, but there is a helpful summary of the key points on the supporting website. It appears to mark a significant watershed in a change of direction and attitude to this complex and vexing issue, though it perhaps does not go far enough in rethinking the whole approach to the questions of sex and identity that have been like a runaway train in the last ten years or so.

What this report also shows (though I am not sure anyone has noted this) is the value of an independent ‘audit’ approach to complex organisations. When an organisation has a range of different entities which communicate imperfectly with one another, then it allows powerful individuals and lobbies to infiltrate into this structure, and without any single person reviewing what is happening, these can significantly influence the decisions that are made with anyone realising. So this question of review and audit is closely related to questions of power and influence.

As a way into the implications of the Cass review and its findings, it is helpful to note some of the responses to it from commentators in this area.

The non-religious group Transgender Trend, who offer a forum for parents of children questioning their sex identity, but who are opposed to transgender ideology, offer their assessment here. There are several interesting things to note.

First, they welcome the holistic approach to child development which has previously been lacking:

Crucially she has considered children and adolescents holistically through a framework of childhood development and adolescent mental health, and within a cultural and social environment unique to this generation…

The information and recommendations in the report de-mystify the condition of gender dysphoria as something that is uniquely specialised, and places it within the appropriate framework of child and adolescent mental health services. As part of a psychosocial treatment pathway it incorporates standard mental health treatments which have been shown to be effective in the treatment of adolescents with a range of difficulties and adverse life experiences.

This holistic approach includes an assessment of the harm that social media and premature access to it through smartphones has caused.

We must also look at the role of the internet, early access to smartphones and the kind of information children are accessing with no proper guidance from adults:

8.47 It is the norm that all experiences of health and illness are understood through the norms and beliefs of an individual’s trusted social group. Thus, it is more likely that bodily discomfort, mental distress or perceived differences from peers may be interpreted through this cultural lens.

8.48 More specifically, gender-questioning young people and their parents have spoken to the Review about online information that describes normal adolescent discomfort as a possible sign of being trans and that particular influencers have had a substantial impact on their child’s beliefs and understanding of their gender.

And they note the way that safeguarding issues have been ‘weaponised’ to prevent proper questions being asked:

The report also references the failure in safeguarding within the clinical setting, which now must also be addressed in other settings. In schools, the same dynamic can be observed when as soon as the word ‘transgender’ is mentioned, all safeguarding responsibilities towards children seem to be forgotten:

10.43 As with all health care provision, when working with children and young people safeguarding must be a consideration. There are complex ways in which safeguarding issues may be present. Clinicians working with children and young people experiencing gender dysphoria have highlighted that safeguarding issues can be overshadowed or confused when there is focus on gender or in situations where there are high levels of gender-related distress.

The overall assessment of what has been happening is damning:

Children have been utterly failed and The Cass Review final report is not just a wake-up call for NHS England, but for the media, for politicians, for childcare professionals and for all adults who have cheerleaded this experiment on children with no questions asked: it has been the failure of society as a whole to safeguard the health and welfare of our children.

So has the Church of England been complicit in this failure by not opposing this damaging ideology?

A second group who have offered a qualified welcome to the Cass review are Sex Matters led by Maya Forstater, who came to prominence when it was ruled that she had been unfairly discriminated against for expressing dissent from gender ideological views and being ‘gender critical.’

The Sex Matters comment is important, because whilst it notes the welcome comments by Cass, it notes that the report is inconsistent in continuing to use language shaped by the ideological assumptions that have directly led to the unscientific and damaging approach to young people.

Hilary Cass’s report demolishes the entire basis for the current model of treating gender-distressed children. Its publication is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base. It’s now clear to all that this was quack medicine from the start.

Dr Cass delivers stinging criticisms of NHS gender clinics, both adult and child, and her description of the Gender Identity Development Service is absolutely damning. It is disgraceful that GIDS, alongside the adult clinics, did not cooperate with her attempt to survey its practice, or to carry out a high-quality, long-term follow-up study on the treatment of children as part of the review, which would have been a global first.

Of course we regard some of the terminology that Cass uses on occasion – cisgender, assigned at birth, and calling boys who identify as girls “trans females” – as inaccurate, unscientific and confusing. But that does not detract from the many important points she makes in this groundbreaking report.

The assessment also draws out the implications for the related, also highly contentious, debate about s0-called ‘conversion therapy’:

If you take her report seriously – and you should: it’s a global standard-setter, far above anything produced anywhere else – you cannot possibly support a legal ban on so-called “conversion practices”. The ethical, careful, multi-disciplinary approach she advocates, in which a child’s gender distress is not “exceptionalised” but understood as just part of what’s going on for a child who is likely to have many other social and medical risk factors, is exactly what the proponents of a ban characterise as “conversion therapy”. They support gender affirmation – which, as Dr Cass’s report demonstrates, is unethical and unsupported by the evidence.

In particular, the Memorandum of Understanding (on conversion therapy in the UK) should now be torn up, since it’s based entirely on the debunked affirmative model. So should the various draft bills banning “conversion therapy”; all are now clearly out of line with the direction of travel and with Dr Cass’s steer for the future of NHS gender medicine.

This is exactly in line with Hilary Cass’ own comments, where she has offered a direct and personal warning to Kemi Badenoch about the dangers here.

The final comment, which is intensely relevant to the Church of England, relates to the role of schools and school culture:

There is one big omission in what is otherwise a remarkably comprehensive and impressive piece of work. Dr Cass lists many factors that influence children to identify as trans, including the media, social-media influencers, friends and their own biology, but omits a particularly important one: schools.

Schools have been a key factor in celebrating and promoting the idea of “trans children” and most children who transition do so in school long before they ever see a specialist clinician. Dr Cass’s review points out that for a child, living “in stealth” – trying to conceal the fact of their actual sex from everyone around them – increases stress anxiety and mental-health problems…

School leaders need to refocus on what the evidence says about supporting children with gender distress, and stop selling the fantasy of “gender transition” when the plain truth is that everyone has an unchangeable sex, and children cannot be kept safe and well when adults lie about that.

Given that the Church of England is a key player in the formation and influence of ‘school leaders’, this finger points fairly directly at us.

Both Forstater and author J K Rowling have highlighted the hypocrisy and guilt of two key organisations who have been behind this ideology, often behind the scenes and covering their own tracks—Stonewall and Mermaids.

Forstater highlights the hypocrisy of Stonewall in welcoming Cass in a series of damning Tweets here:

And J K Rowling demonstrates that, contrary to their claims now, Mermaids continue to recommend the things which Cass specifically highlights as deeply damaging to children:

I am happy to be corrected, but I cannot recall a single occasion when bishops of the Church of England have retweeted comments from either Forstater or Rowling, or expressed support for their campaigning on this issue. Why not?

In all this, journalist Hannah Barnes challenges, where have all the people who should have known better been? Where has the NHS been in not challenging this? Where have the media been? Where has the BBC been? And, we might well add ‘Where has the Church of England been?’

Tom Swarbrick, on LBC radio (on whose show I have appeared a couple of times) is absolutely scathing:

This was an experiment carried out on the back of vulnerable children who were encouraged by medics to believe in a medical untruth—namely, that you can be born in the wrong body. And the people who said for years that there is something wrong here, that this isn’t safe or isn’t scientific, got told they were the problem—they were the ones inflaming the cultural war—and the irony being that those most angered by the culture was used the fog of that apparent conflict to block the truth because the reality was too confounding for them.

The ‘be kind’ brigade stopped thinking. They were seduced by the language of ‘being born in the wrong body’. The reality is, no one is ‘born in the wrong body.’ You may feel you are, but you aren’t. You should be entitled to the best possible help for that feeling because it must feel absolutely horrible. But we don’t need to sacrifice fact on the altar of those feelings and, less rhetorically, the NHS never needed to endanger the health of thousands of children, because the adults in the room forgot to challenge feelings with facts.

It is very hard indeed not to include many in the Church of England, especially its leadership, in the misguided ‘be kind’ brigade.

So it quite astonishing that Jayne Ozanne, who has been so influential in these debates as a former member of Synod, is still resisting the evidence of Cass:

That this is a deeply theological question, calling for courageous engagement, is highlighted by this moving piece from Anne Snyder in Comment online magazine:

This [is] a pathologically Western moment as our disintegrating culture thrusts its talons into yet another aspect of our created design—in this case the unity of body and soul as expressed in one’s maleness or femaleness. And I must state what I see: We are losing to chaos, a chaos of meaning and of personhood.

It doesn’t take much to be discombobulated by the different streams of data flowing into one boiling cauldron. For starters, the boys are not all right. They are outperformed by girls in most academic disciplines, they are more likely to feel socially excluded, boys raised in poverty are less likely than girlsto escape it, and all are tossed about by prohibitions on “toxic masculinity” without recourse to a positive vision for healthy masculinity. Meanwhile girls’ interior lives are suffering: The Centers for Disease Control found that between 2009 and 2015, emergency-room admissions for self-harm among ten- to fourteen-year-old girls had tripled, and that in 2021, nearly one in three high school girls had considered suicide, a 60 percent increase since 2011. Separately (though simultaneously), between 2013 and 2020, girls between the ages of thirteen and seventeen seeking mastectomies increased thirteenfold. Rates of adolescent gender transition have skyrocketed, with the number of boys and girls seeking medical intervention having risen 3,600 percent over the last decade. The surge most pronounced in patients was between the ages of twelve and eighteen. Forty-two thousand children and teens across the US were diagnosed with gender dysphoria in 2021, nearly triple the number in 2017.

Where are the adults? As these dramatic trendlines have shot up, our culture’s only mechanism for imposing some form of “order” seems to be the English language. Elite institutions and their progressive consensus have returned to familiar tactics: Impose new verbal rules without warning or a clear telos, bend reality whenever necessary to conform it to the whims of that ever-shifting consensus, and prop it up and proclaim it universal. Comment has covered these dangers previously in our Beyond Ideologies issue; the devil may find new terrain, but his devices are ever the same.

All this raises major questions for the Church of England, for Synod, and for the whole approach on this issue for C of E Education and schools:

1. What has been the influence of Mermaids and Stonewall in policy and practice, both at a national level, in guidance, and at a local level in Church of England schools? What guidance will now be issued about screening organisations who are invited into C of E schools?

2. How have we allowed ideological entryism to have such a powerful grip on discussions at a national level in the Church?

3. What do we need to do to recover a proper theological vision of what it means to be a child, what it means to grow to maturity, and the role of education in this? What is the distinctive Christian vision of education that the Church of England has to offer?

4. When will the deeply flawed report ‘Valuing All God’s Children’ be scrapped, and what will be offered in its place?

5. How and when will the Church of England revisit its uncritical support for ‘Conversion Therapy’ bans?

6. Why has campaigning against a damaging ideology which has harmed children been left to secular campaigners? Where has the voice of the Church of England and its bishops been in this debate? Why have we been so slow to speak up?

7. When will the Church of England join voices campaigning for the protection of childhood in restricting the use of smartphones—and when will it at last speak up for the importance of marriage and parenting?

Dean Inge’s famous dictum ‘Whoever marries the spirit of this age will find himself a widower in the next’ is coming home to roost for the Church of England’s approach to children, education and families. Worse than that, the Church of England looks like it has colluded in creating a generation of orphans, depriving them of the spiritual parental care that we should have been offering.

Something radical needs to change.