The Cass Review has found that the only NHS gender identity service for children in England and Wales is under unsustainable pressure as the demand for the service outstrips capacity.

Commissioned by NHS England in 2020, the interim report recommends that a network of regional hubs be created to provide care and support to young people with gender incongruence or dysphoria, arguing their care is ‘everyone’s business’.

Regional hubs would bring treatment closer to those who need it, allow more clinicians from a variety of backgrounds to offer support, and develop agreement and guidance about the appropriate clinical assessment process that should take place, underpinned by better data and evidence.

The report explains that the significant rise in referrals to the Gender Identity Development Service (GIDS) at London’s Tavistock and Portman NHS Foundation Trust has resulted in overwhelmed staff and waiting lists of up to two years that leave young people ‘at considerable risk’ of distress and deteriorating mental health.

Data shows that the number of referrals to the service went from 138 in 2010-11 to 2,383 in 2020-21.

The review also states that a ‘clinician lottery’ exists for children and young people as a result of differing views and lack of open discussion about the nature of gender incongruence in childhood and adolescence. It notes that the clinical approach used by GIDS ‘has not been subjected to some of the usual control measures’ typically applied with new treatments.

Additional concerns were also expressed over tensions between the expectations of the young person – who often wants rapid access to physical interventions after a long, challenging wait to be seen – and the responsibilities of the clinician.

The review is being led by the paediatrician Hilary Cass.