Thread by @hannahsbee

BREAKING. The Government has established a Working Group to look at whether prescription of cross-sex hormones (CSH) will, like puberty blockers, should be banned to under 18s, outside of NHS (ie private & overseas providers). The group is expected to report back in July.

The news came during a hearing at the High Court today. Former Tavistock patient, Keira Bell (KB) had sought Judicial Review against Health Sec Wes Streeting and NHS England about decision to allow the prescribing of CSH, despite evidential concerns about safety for children

Arguing on behalf of Ms Bell, Zoe Gannon (ZG) explained that Streeting (WS) himself had described what happened at the Tavistock GIDS as a “scandal”, “where children suffering from gender-related distress were treated on the NHS” based on evidence which was “at best, weak”.

ZG: Does shy away from the word scandal. “And it is a scandal, I say, that this is being allowed to continue with the prescription of CSH in the private sector”

ZG quotes KB’s witness statement: “I made an ill-considered decision as a teenager - a lot of teenagers do. However, this was encouraged & set in stone by the largest health institution in this country… I cannot reverse any of the physical, mental ... changes I went through.”

ZG argued no reason to treat PB and CSH differently. Hilary Cass wasn’t asked to weigh up the relative risks of PB and CSH, she says, “she was obviously concerned about both”, and recommendations essentially the same for both: “extreme caution”, part of wider research prog...

...and both should be part of review by nation MDT. No reason to distinguish between the two when it comes to gov response to both treatments.

ZG says that at the point where SoS considering PB ban, it was acknowledged “a full order could also include CSH subject to medical advice”. It was at least in minds of ministers that permanent order cld include CSH as well as PB. Judge points out no decision was made

ZG argues that for last year Gov has treated PB and CSH in "fundamentally different way" without an explanation. Judge said it may well be they haven't made a decision yet. ZG says but they don't appear to have been doing any work looking at CSH;they "should have been doing more"

If all they have done is spoken to stakeholders, then it is arguable that there has been "process irrationality" - and this warranted more than what gov has done.
Judge seeks to clarify: Cass made clear that PB fell into same boat as PB ...

...and against that backdrop SoS had to get on with it. Banned PB. You say that's not good enough and Cass made it obvious that the two - PB and CSH - should have run in tandom?
ZG: Yes

Dec 11 2024 - announcement on PB ban.
ZG reads from response provided to them in Feb 2025: "The Department remains of view that it's neither necessary or appropriate to.... restrict the use of CSH" to children under 18.

May 2025 - get told that the Gov has set up a working group to look at CSH. We obviously welcome that, but we ask why couldn't this have happened earlier? We say that strengthens our case.
Judge: "it's a lot to say the government is acting irrationally"

Judge: If we were to give you that point - and allow the JR to proceed - to what end?
ZG: In that delay children have been exposed to harm. The risk is that these children have been exposed to the same path as KB.

ZG: "There can be nothing to protect these children from risk other than the SoS acting"
There is value in a court declaration saying that what happened was "irrational." "It is not rational for a SoS to do nothing, knowing these risks."

ZG: The setting up of the working group does not render our argument "academic" - question remains whether SoS was acting unlawfully in treating PB and CSH differently...

Also, this is only first step. There is no ban - either temporary or permanent - so case has not been taken over by events. ZG repeats argument that Cass view on risk was the same - PB is clinical trial, CSH "extreme caution" - no major dif. Therefore "irrational" to treat dif.

ZG: Cass expresses fear about private prescribing - that was not restricted to just PB - but to both medications
Judge - you're saying that private prescribing was a universal concern?
ZG: Yes

ZG: Cannot say that CSH are less of a risk to PB, in fact we say they are more of a risk because of their irreversible nature, and that is what led to KB's "disoriented state", that she describes in witness statement.

Mr Steel now speaking on behalf of SoS. Says extra work is now being carried out that may well lead to the measure the claimants want - rendering the application for JR unnecessary.

Says he wants to clarify what Cass said - she recommended that puberty blockers should not be offered to those under 18 for the treatment of gender dysphoria or incongruence, save only under the governance of a research protocol and a clinical trial.

By contrast, the Cass Review noted that the option of providing CSH from age 16 remains available, and recommended only that NHS England should review its policy and that caution should be exercised. That review is underway.

There are key distinctions betw the two treatments, and their availability on the NHS. CSH are available on the NHS

S: Cass recommendation 27 - both Cass and the department have considered S62 powers - (banning prescription). Those actions re: PB ban were made in face of objections and legal challenge this is an area which "strongly divides" opinion.

Gov looking at a potential ban of CSH but not yet at the point where statutory threshold has been met.
They have not seen evidence of widespread overseas prescription of CSH to children. Not seen from pharmacists either.

New evidence provided by the claimant in March 2025 - from expert witnesses based in Finland and Sweden - is what has made the gov reconsider course of action and set up the working group - NOT the fact that they were facing JR.

The case on PB was "open and shut". There had previously believed not to be evidence to implement similar ban on CSH.
ADJOURNED FOR LUNCH