Hilary Dawn Cass, Baroness Cass, OBE, FRCN, FRCGP (born 19 February 1958), is a British paediatrician. She was the chair of the British Academy of Childhood Disability, established the Rett Clinic for children with Rett syndrome, and has worked to develop palliative care for children. She led the Cass Review of gender identity services in England, which was completed in 2024. Cass was appointed to the House of Lords as a crossbench life peer in the same year.
Cass spent her early medical career in a general practice training scheme, during which she changed to paediatrics.[6] From 1992 to 2018, she was a consultant in neurodisability at three tertiary centres in the UK.[1] Her research and interests have included autistic spectrum disorders, cognitive impairment due to epilepsy, children with visual loss, and care of children with multiple disabilities, particularly where there are difficulties with feeding and communication.[5] In this field she has higlighted that medical innovations have resulted in a greater survival rate of children with severe incurable diseases, with the result that there are a greater number of children with severe disabilities.[7]
From 1994 to 2009 Cass was consultant in paediatric disability at Great Ormond Street Hospital (GOSH).[4] There, she was appointed director of Postgraduate Medical Education and held the post of deputy medical director.[5] During that 15-year period she also held some regional and national positions in medical education and policy development, including head of the London School of Paediatrics.[5][11] At GOSH, she authored a book titled Snakes and Ladders, based on a programme she led that used role play to understand patient journeys in the NHS and to teach staff clinical governance skills.[5][12][13] The book addresses communication between doctors and patients, and primary and secondary care.[13] Other topics covered include informed consent, medical negligence, medical paternalism, randomised controlled trials, and unlicensed treatments.[13]
In 2008 she published findings that did not support the opioid excess theory.[14] She reported on a large study she led that found no difference in urinary opioid peptide levels between those with autism and control subjects, and concluded that "opioid peptides can neither serve as a biomedical marker for autism nor be employed to predict or monitor response to a casein- and gluten-free diet".[14][15]
Cass left GOSH after raising concerns about patient safety at the hospital.[16] The hospital denied that she quit over patient safety concerns.[17]
Evelina Hospital
Cass joined the Evelina Hospital as consultant in 2009.[18] There, she developed palliative care services for children.[1]
In September 2020, Cass was appointed to lead the independent Cass Review for the NHS into gender identity services for children and young people.[1][19] The interim report of the Cass Review was published in March 2022.[20] It said that the rise in referrals had led to the staff being overwhelmed, and recommended the creation of a network of regional hubs to provide care and support to young people. The report noted that the clinical approach used by the Gender Identity Development Service (GIDS) "has not been subjected to some of the usual control measures" typically applied with new treatments, and raised concerns about the lack of data collection by GIDS.
[21][22][23] The recommendations resulted in the closure of GIDS.[24] The final report was published on 10 April 2024.[25]
Cass said after the publication of the review that she had received 'vile' emails and that she was not travelling by public transport after receiving security advice. She also said that she would not participate in the forthcoming review of adult gender clinics.[26]
In May 2024, she made her first US media interview, on WBUR-FM's On Point, whom she told "The evidence was disappointingly poor". Cass also responded to WPATH's criticism about prioritising non-medical care, saying the review did not take a position about which is best. Cass hoped that "every young person who walks through the door should be included in some kind of proper research protocol" and for those "where there is a clear, clinical view" that the medical pathway is best will still receive that, and be followed up to eliminate the "black hole of not knowing what's best". On the allegation that the review was predicated on the belief that a trans outcome for a child was the worst outcome, Cass emphasised that a medical pathway, with lifetime implications and treatment, required caution but "it's really important to say that a cis outcome and a trans outcome have equal value".[27]
In an interview with The New York Times in May 2024, Cass said that US doctors were 'out of date' on gender care. However, she also expressed concern that her review was being weaponized to suggest that trans people do not exist, saying "that's really disappointing to me that that happens, because that's absolutely not what we're saying." She also clarified that her review was not about defining what trans means or rolling back health care, stating "There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access — under a research protocol, because we need to improve the research — but not assume that that's the right pathway for everyone."[28]
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