Cass review: implications for schools and colleges

In April 2024, Dr Hiliary Cass published her final independent review of gender identity services for children. It concluded that there is no good evidence which considers the long-term outcome of interventions to manage gender-related distress in children and young adults. Dr Cass made a number of recommendations based on the information currently available. 

The report focusses on medical treatment and its recommendations are directed at medical staff. However, Dr Cass recognises that the journey to transition doesn't begin at the front door of the NHS but in the ‘home, family and school environment’. She went on to say that the impact of what happens in schools ‘cannot be underestimated’ and that schools and colleges need guidance that utilises some of the principles and evidence set out in the report.

What sections of the report relate to schools and colleges?

The report looks at social transition which is generally taken to mean social changes: children may live as a different gender, alter their hair, clothing and use a new name and different pronouns. 

Dr Cass makes clear that there are different views about the benefits and harms of social transition. Some argue that it improves the mental health of children experiencing gender-related distress, others that it may make it more likely that a child's gender dysphoria, which may be resolved at puberty, has an altered trajectory, potentially culminating in life-long medical intervention. Dr Cass says that in the UK and internationally, it is now the norm for many children and young people to present to gender clinics having undergone full or partial transition.

The evidence for and against social transition

The report states that there is ‘no clear evidence that social transition in childhood has any positive or negative mental health outcomes and relatively weak evidence for any effect in adolescence'. However, 'those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway’. 

The available studies do not tell us whether earlier social transition was causative of this outcome. In the absence of clear evidence, the report says that medical staff should help families to recognise normal developmental variation in gender roles, behaviour and expression. And they should ‘avoid premature decisions and consider [that] partial rather than full transitioning can be a way of ensuring flexibility and keeping options open until the developmental trajectory becomes clearer’.

How should schools and colleges respond?

Dr Cass recognises that schools have been grappling with how to respond when a pupil says that they want to socially transition in a school setting. She does not, however, include any specific recommendations directed at schools, other than saying that policies should be in line with the evidence set out in her report.

In December 2023 the government published draft guidance for schools and colleges on gender questioning children. It recommends that educators adopt a ‘cautious approach’ and should not 'proactively initiate action towards a child's social transition'. That certainly appears to be in line with the recommendations of the Cass report which is hardly surprising since it quotes the interim Cass review which found that social transition is not a neutral act.

The guidance provides detailed advice on handling different information requests such as changing the name and pronouns of children; single sex spaces including toilets, changing rooms and showers; boarding and residential accommodation; uniforms; physical education and sport; and single sex schools. This guidance is non-statutory and is subject to a consultation which is now closed. Although the advice provided is clear, some commentators have suggested that, if a school uncritically relies on this, it could expose them to legal claims. 

Our experience suggests that many educational establishments are confused about the law and, generally, are more inclined to affirm a child's identity by allowing them to socially transition at school/college than follow an approach in line with the draft guidance. Whilst Dr Cass acknowledged that adolescents have more personal agency than children in terms of how they identify, that does not mean that it will be appropriate to always socially transition older pupils. Schools and colleges will need to consider what is best for the individual child or student, usually in consultation with their parents and/or other qualified professionals.  

Schools that have adopted a toolkit, similar to the one introduced by Brighton and Hove Council in 2021 and replicated by a number of other local authorities may also have to re-consider their approach. The toolkit provides that schools should respect a child's request to change their name and pronoun as a ‘pivotal’ part of supporting their identity, as well as other changes such as switching to wearing trousers or a skirt. A legal opinion published by Karon Monaghan KC concludes that schools and councils using the toolkit are very likely to be in breach of equality and human rights legislation and could be sued by unhappy parents. She also says that forcing staff to use a child's chosen pronouns would be in direct conflict with the beliefs of staff and other children who are gender-critical and could violate their rights.

The legal arguments around social transitioning in schools and colleges are complex. We recommend that you take advice if you asked to support socially transitioning a pupil or student. We have an excellent public law team, headed up by Yogi Amin who can help you reach a legally defensible decision.  

Our newsletters

We publish monthly employment and education newsletters. If you'd like to be added to the mailing list, please let me know. 

The striking increase in young people presenting with gender dysphoria should be seen within the context of increasing rates of poor mental health and emotional distress among the broader adolescent population, particularly among girls, the Cass report found.

There has been a substantial increase in rates of mental health problems in children and young people, with increased anxiety and depression being most evident in teenage girls, UK national surveys between 1999 and 2017 show.”