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Despite the Cass Review and the Supreme Court ruling in April 2025 the problem of gender activism in the NHS is deep rooted and seems impervious to reason or evidence. The two biggest unions representing doctors and nurses cling onto the discredited approach of gender affirmation. The BMA claims a ‘neutral’ position on Cass while their promised evaluation of Dr Cass’s findings is over a year behind schedule. The main nursing union the RCN has not issued a statement or responded publicly to the Review. Indeed a search on the union’s website brings up ‘no results’ for the Cass Review. There are a good number of pro-trans articles and gender affirming features however.

But it’s not clear if there would be any difference on the ground even if, at the top level, the BMA and the RCN were whole-heartedly behind all of Cass’s recommendations. We know about the power of LGBT staff networks in areas such as teaching, policing and journalism and how they prevent open debate about sex and gender. These staff networks are in turn supported by outside LGBT groups who offer training and policies. It helps too if there are senior individuals in the organisation who reinforce the genderist message. But the NHS is unique because it’s where the ideology meets actual bodies. It matters when medics refuse to engage with evidence.

Capture at CEO level

We attended a recent LGBT NHS conference held at King’s College Hospital in London which encapsulates the problem perfectly. Senior NHS staff mixed with groups like Gendered Intelligence, the LGBT Foundation and Transactual. There were staff from the Department of Health there too, sporting pronoun badges. Stalls offered free booklets full of misinformation about puberty blockers and suggestions on how to get round the ban.

The all-day event was introduced by the CEO of Kings College Hospital, Professor Clive Kay, lanyarded with the Progress flag. A radiologist by training, he told us he was proud of King’s College Hospital’s advocacy for LGBTQ+ identities and of their staff network, King’s and Queers.

Wearing the politicised Progress lanyard with its transgender, Q+ and intersex symbols was not a polite gesture to his audience. Clive Kay knows what the flag represents. In 2023 he attended the unveiling of a Progress flag design on a new walkway, alongside Valentino Vecchietti, the designer of the “Intersex-Inclusive” flag, saying:

“The new bridge is part of our work to make sure patients and visitors have the best experience possible when they visit us. We were also delighted to be able to feature the Intersex-Inclusive flag as part of its design.”

As a consultant and hospital boss, he surely knows that ‘intersex’ is an activist term that seeks to co-opt the rare cases of DSDs or Disorders of Sexual Development to the transgender cause.

King’s and the affirmative gender clinic

Kay went on to speak about how proud he was of King’s relationship with the cliniQ clinic.

cliniQ was set up in July 2019 with the help of King’s to provide a sexual health service for ‘trans, non-binary and gender diverse’ patients. They don’t prescribe but can offer support to patients taking hormones or contemplating surgery. They’re part of a coalition of other activist health groups who spread alarmist messages about the EHRC following the Supreme Court ruling on the definition of sex in the Equality Act:

“We believe the EHRC guidance is not fit for purpose and should be withdrawn. It is unworkable, impractical, and inconsistent.”

cliniQ is semi-detached from the NHS, allowing it room to lobby against the law of the land, but benefits from the endorsement of King’s and the patronage of Dr Michael Brady, the NHS’s National Advisor for LGBT Health. They provide training for all departments at King’s as Michelle Ross of cliniQ told an online audience in 2023:

“….our doctors at Kings are not trans but they are very involved in trans care ….We do a lot of training within King’s Hospital. We have a program of training for all departments on  trans people’s health and well-being. We do focus some on the gender care aspect, but also the whole health that we as humans experience.”

Brady’s close relationship with the LGBT Foundation

Dr Brady was in charge of running the conference and he began by announcing a delay. We had to wait until the keynote speaker, the Health Secretary, Wes Streeting, who was to speak second, was actually in his seat before Paul Martin, CEO of the LGBT Foundation, would begin. It felt like a set-up. Mr Streeting then had to listen to half an hour of special pleading by Martin: the EHRC had created a toxic environment, the LGBT+ community feels under threat, there’s slow progress on the conversion therapy ban. Paul Martin wanted to see the LGBT Foundation’s pet projects, the Rainbow Badge Scheme and Pride in Practice, re-instated and scaled up.

It was hard to square this picture of marginalisation while sitting in a state of the art auditorium in a major London Hospital. In fact the LGBT Foundation works closely with Dr Brady as Paul Martin made clear. He and Dr Brady are going on a 30-day tour of different NHS regions to encourage submissions on LGBTQ+ healthcare to the NHS’s 10 year review. This seems like a seat at the top table, something denied to groups such as Transgender Trend, SEGM and CAN-SG who highlight the harms of puberty blockers and cross-sex hormones.

Mixed messaging from Wes Streeting

The Health Secretary picked up on some of these themes in his speech, echoing without any evidence Paul Martin’s toxicity claims and repeating unreliable suicide statistics. But for all his apparent empathy for those attending, he offered little of substance to the activists in the audience.

The big announcement was a pilot scheme in the South West to provide online support for anyone over 18 who is on the gender clinic waiting list. This is a sop, albeit one costing £125,000, money that could be better spent. A similar scheme is already offered to those on the waiting lists at the Nottingham GIC, East of England GIC and the Exeter GIC. So it is not clear how new this initiative is and whether the South West covers a bigger area than the Exeter clinic.

These three clinics have outsourced their online advice service to Gendered Intelligence so anyone over 18 will get undiluted affirmative advice from the most outspoken lobby group for medicalised gender care. It’s possible that Gendered Intelligence may get the contract for this new scheme. It’s lucrative. In June 2024 Gendered Intelligence’s  annual report to the Charity Commission said they’d received £158,090 from government contracts.

Most of the questions in the Q&A were about Wes Streeting’s decision to ban puberty blockers. Streeting gave the consistent answer that he would always follow the evidence and would not override the advice of doctors:

“My only motive is that medicine given to children is safe and effective and grounded in robust evidence”

The head of the private Gender Plus clinic, Aidan Kelly, asked from the audience about cross-sex hormones for the under 18s:

“We provide the only regulated pathway for gender affirming hormone care outside the NHS for under 18’s in this country. Last year we saw more under 18 patients than the three NHS early level services combined. Minister, you and your department are apparently considering banning the provision of this treatment for under 18s in the private sector.  Nobody from your department has spoken to us, the sole providers of this care.  Will you commit to meeting with us, so your team can learn about what a standard of care in this field looks like…?”

It’s some relief to know that the Health Secretary has not met Gender Plus as part of the DHSS’s review of cross-sex hormones. Gender Plus is currently circumventing the puberty blocker ban by jumping over the puberty suppression stage and offering irreversible hormones to children over 16. The DHSS review must ban these harmful drugs both in the NHS and in private clinics. If Wes Streeting follows the evidence this is the only conclusion he can reach.

The LGBT Foundation: the gender affirmative private provider

The LGBT Foundation’s role in the conference was central. In addition to the major speech by the CEO Paul Martin it ran two further sessions. One argued that ‘gender identity’ monitoring must be standard on all NHS records. The second session was a plea for the LGBT Foundation’s schemes Pride in Partnership and the Rainbow Flag to be funded and rolled out across the NHS. Funding for the badge was stopped by the DHSS in February 2024. The Foundation calls the Pride in Practice scheme a quality assurance programme but they set the benchmarks and carry out the assessments. In essence they mark their own homework.

The LGBT Foundation is hardly a struggling marginalised outsider. They employ around 100 people and since December 2020 they’ve been running Indigo, one of the ‘pilot’ gender clinics, in partnership with a GP consortium. For this they were paid £902,798 in 2023 according to the Foundation’s latest filed accounts. As we’ve argued before these pilot clinics are neither clinical nor pilots. They provide only affirmative care, and undermine the holistic approach recommended by the Cass Review.

The contracts for the pilots have been renewed without independent re-evaluation. In 2023 they were evaluated by the NHS team which set them up, the National Specialised Commissioning Team. They found that Indigo “did not establish a process for the collection of Patient Reported Outcome Measures and Patient Reported Experience Measures.”

It’s no surprise that data collection is a problem for gender clinics. This has been a feature of all gender clinics, most notably at GIDS.

A second serious problem was highlighted:

“In June 2021 NHS England became aware, through routine contract monitoring arrangements, that aspects of the service’s delivery model were contrary to the service specification, in that a small number of patients had been referred by the service for voice and communication therapy or psychological therapies before they had been diagnosed (at their second appointment with a clinician from the service). The patients had, therefore, not met the criteria for gender dysphoria related to gender incongruence before being accepted on to the NHS care pathway.”

In other words, Indigo jumped the gun and offered services before any formal diagnosis. The evaluation says this matter has now been resolved and that the clinic adheres to the service specifications. But for the gender activists within the NHS this justifies further involvement of LGBT groups within the NHS. The evaluation goes on to say:

“there is a cohort of patients who may need additional support before (our emphasis) being seen by a specialist gender dysphoria service…..the needs of this patient cohort are best served through a separate local pathway – outside of specialist gender dysphoria services – that may lead to a range of therapeutic options that meets the individual’s need…”

It’s possibly this thinking that led to Wes Streeting’s conference announcement of a similar support service for the South West. We know that the adult gender clinics are seeing a younger patient cohort with a changing sex ratio of male to female. Unfortunately the only ‘support’ they will receive will be affirmative.

The activist focus on cross-sex hormones

It’s clear too that groups like Gendered Intelligence, who run the existing support services, and the LGBT Foundation recognise that they have lost the argument, for the moment at least, over puberty blockers. The Foundation still argues for these harmful drugs to be given to adolescent children but their energies are concentrated on the young adults who, once they reach sixteen, may be on a path to cross-sex hormones. While lamenting the ban they point out on their website:

“There is no ban on children and young people aged 16+ beginning gender-affirming hormone treatment.”

When faced with a legal challenge in June this year, Wes Streeting’s office said it was holding an urgent review of cross-sex hormones for 16-18 year-olds. We hope Mr Streeting will continue to follow clinical advice and robust evidence and ban these experimental treatments. The LGBT NHS conference was a perfect example of the opposition he and the NHS face in combatting genderism in the health service. He needs to know that he will be supported by a much bigger audience of parents and clinicians if he takes this brave step.