DR HILARY Cass has submitted her final report into the review of gender identity services for children and young people and her recommendations for NHS England. It has been four years in the writing, and despite resistance and non co-operation by some involved in the service, it provides a comprehensive overview of what went wrong, and why. She has emphasised the lack of robust clinical evidence to support the treatments prescribed by the Tavistock Gender Identity Service in the management of children presenting with gender incongruence, and the lack of evidence as to the outcomes of the social transitioning of young children. She has highlighted the toxic culture surrounding the whole issue of gender re-assignment resulting in many clinicians being fearful of working with such children, or of questioning the use of puberty-blocking drugs, or the issues of social transitioning.

All well and good! It is an excellent report which I hope and pray will be taken seriously and acted upon by the Government, the NHS, schools and anyone who has an interest in and care for children and young people. My only issue is, why has it taken so long?

In April 2016, Brighton and Hove City Council (where else?) wrote to the parents of four-year-olds due to start primary school, asking that children be allowed to choose the gender they most identified with.

The letter said: ‘We recognise that not all children and young people identify with the gender they were assigned at birth or may identify as a gender other than male or female, however the current systems (set nationally) only record gender as male or female.