Hilary Cass Explained

Hilary Cass
Education:Royal Free Hospital Medical School
Occupation:Paediatrician
Profession:Physician
Field:Paediatric disability
Work Institutions:
Research Field:Neurodevelopmental disorders

Hilary Dawn Cass is a British paediatrician known as chair of the British Academy of Childhood Disability, for establishing the Rett Clinic for children with the Rett syndrome neurodevelopmental disorder, for developing palliative care for children, as well as for leading the Cass Review completed in 2024. In the 2024 Dissolution Honours, Cass was nominated for a life peerage as a crossbencher.[1] [2]

Cass is a former president of the Royal College of Paediatrics and Child Health, and a honorary physician in paediatric disability at the Evelina Hospital, part of Guy's and St Thomas' NHS Foundation Trust. Prior to Cass's appointment at the Evelina Hospital, she had been consultant at Great Ormond Street Hospital for 15 years. 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.

Early life and education

Hilary Cass completed her early education at the City of London School for Girls.[3] [4] She studied at the Royal Free hospital medical school, graduating with a degree in medicine in 1982.[5]

Career

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.[7] 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.[8]

Rett syndrome

In 1992 Cass founded the Rett clinic, a national outpatient service for children with the neurodevelopmental disorder Rett syndrome, based at the Evelina Hospital, part of Guy's and St Thomas' NHS Foundation Trust.[9] [10] She later reported that self-injurious behaviour in Rett Syndrome had a prevalence of 73.8%.[11]

Great Ormond Street Hospital

From 1994 to 2009 Cass was consultant in paediatric disability at Great Ormond Street Hospital (GOSH). 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] [12] 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] [13] [14] The book addresses communication between doctors and patients, and primary and secondary care.[14] Other topics covered include informed consent, medical negligence, medical paternalism, randomised controlled trials, and unlicensed treatments.[14]

In 2008 she published findings that did not support the opioid excess theory.[15] 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".[15] [16]

Cass left GOSH after raising concerns about patient safety at the hospital.[17] The hospital denied that she quit over patient safety concerns.[18]

Evelina Hospital

Cass joined the Evelina Hospital as consultant in 2009.[19] There, she developed palliative care services for children.[7]

Cass Review

See main article: article and Cass Review. In September 2020, Cass accepted an appointment to lead the independent Cass Review for the NHS into gender identity services for children and young people.[7] [20] The interim report of the Cass Review was published in March 2022.[21] 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.[22] [23] [24] The recommendations resulted in the closure of GIDS.[25] The final report was published on 10 April 2024.[26]

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.[27]

In May 2024 she made her first US media interview, on WBUR-FM's On Point, whom she told "The evidence was disappointingly poor".[28] According to the New York Times, she said that US doctors were ‘out of date’ on gender care.[29]

Other roles

In 2012 Cass was appointed president of the Royal College of Paediatrics and Child Health for a three-year tenure.[30] [31] Between 2017 and 2020 she was chair of the British Academy of Childhood Disability.[7] She is a trustee of Noah’s Ark Children’s Hospice, and was formerly chair of the charity Together for Short Lives.[7] [10]

Honours and awards

Cass was appointed an Officer of the Order of the British Empire (OBE) in the 2015 New Year Honours for services to child health.[32] [33] In the same year the Royal College of Nursing awarded her an honorary fellowship (FRCN), and the following year she received one from the Royal College of General Practitioners (FRCGP).[7]

In the 2024 Dissolution Honours, Cass was nominated for a life peerage as a crossbencher.[34] [35]

Personal life

Cass is Jewish[36] and signed an open letter after the 7 October 2023 attack on Israel affirming her "Jewish values",[36] including endorsing the existence of the State of Israel and a two-state solution for the Israeli–Palestinian conflict.[36]

Selected publications

Papers

Books

Bibliography

Further reading

Notes and References

  1. Web site: Dissolution Peerages 2024 . 2024-07-04 . GOV.UK . en.
  2. News: Elgot . Jessica . 2024-07-04 . Sunak’s chief of staff and Theresa May among Tory peerages in dissolution honours . 2024-07-04 . . en-GB . 0261-3077.
  3. Web site: Dr Hilary Cass OBE . City of London School for Girls . 13 April 2024 . https://web.archive.org/web/20240413105039/https://clsg.org.uk/alumnae/dr-hilary-cass-obe/ . 13 April 2024.
  4. News: Campbell . Denis . 4 September 2012 . 'We're doing medicine in a really inefficient way,' says RCPCH leader . https://web.archive.org/web/20240412112822/https://www.theguardian.com/society/2012/sep/04/medicine-inefficient-way-rcpch-leader . 12 April 2024 . 30 August 2015 . The Guardian.
  5. Web site: Dr Hilary Cass . RCPCH . Royal College of Paediatrics and Child Health . 13 April 2024 . https://web.archive.org/web/20240413090450/https://www.rcpch.ac.uk/about-us/our-team/dr-hilary-cass . 13 April 2024 . en.
  6. Cass . Hilary . Mistry . Ravi . Championing children’s health . British Medical Journal . 27 March 2013 . 346 . 10.1136/sbmj.f1775 . en . 1756-1833.
  7. Web site: The Chair – Cass Review . cass.independent-review.uk . 13 April 2024 . https://web.archive.org/web/20240413121357/https://cass.independent-review.uk/about-the-review/the-chair/ . 13 April 2024 . en.
  8. Goo . Minjin . Kim . Yujeong . Factors affecting nurses' attitude toward withdrawal of life-sustaining treatment for children . Journal of Pediatric Nursing . 11 March 2024 . S0882–5963(24)00085–X . 10.1016/j.pedn.2024.03.008 . 38472026 . 1532-8449. subscription.
  9. Web site: Rett clinic Evelina London . www.evelinalondon.nhs.uk . St Thomas' Hospital . 13 April 2024 . https://web.archive.org/web/20240413125740/https://www.evelinalondon.nhs.uk/our-services/hospital/rett-clinic/overview.aspx . 13 April 2024.
  10. Web site: Dr Hilary Cass on her new role at Together for Short Lives and the future of children’ s palliative care - ehospice . ehospice.com . 17 April 2024 . https://web.archive.org/web/20240417043525/https://ehospice.com/uk_posts/dr-hilary-cass-on-her-new-role-at-together-for-short-lives-and-the-future-of-children-s-palliative-care/ . 17 April 2024.
  11. Book: Furniss . Frederick . Biswas . Asit B. . Self-Injurious Behavior in Individuals with Neurodevelopmental Conditions . 2020 . Springer . 978-3-030-36015-3 . 68 . https://books.google.com/books?id=GG_NDwAAQBAJ&pg=PA68 . en . 3. Neurobiology of self-injurious behaviour: Rett syndrome.
  12. https://books.google.com/books?id=B4FtDgAAQBAJ&pg=PA198 Craft, p. 198
  13. Gandhi . V. . The NHS experience: The "Snakes and Ladders" guide for patients and professionals . Arch Dis Child . July 2006 . 91 . 7 . 625 . 10.1136/adc.2006.095836 . 14 April 2024 . 2082820 .
  14. Sanai . Leyla . How to use the NHS . The Lancet . February 2006 . 367 . 9511 . 642 . 10.1016/S0140-6736(06)68247-0 .
  15. Book: Keith E. . Keith . Paediatric Gastrointestinal Disorders: A Psychosocial Perspective . Field . Douglas G. . Alexander . Chandran P. . 2019 . Taylor and Francis . 978-1-909368-36-1 . Martin . Clarissa . 226 . en . Autism and spectrum disorders and gastrointestinal problems: current state of the research and implications for practice . Dovey . Terence . https://books.google.com/books?id=2S6ODwAAQBAJ&pg=PT226.
  16. Book: Fitzpatrick . Michael . Defeating Autism: A Damaging Delusion . 2008 . Routledge . London . 978-0-415-44980-9 . 198-199 . en.
  17. News: Campbell . Denis . 26 June 2013 . Great Ormond Street Hospital gagged top doctor after safety fears raised . 30 August 2015 . The Guardian.
  18. Web site: Article in the Guardian . 2024-07-06 . GOSH Hospital site . en-GB.
  19. Web site: Consultant takes office as the president of RCPCH . Guy's and St Thomas' NHS Foundation Trust . 14 April 2024 . 11 April 2024.
  20. Web site: Marsh . Sarah . 22 September 2020 . NHS to hold review into gender identity services for children and young people . 13 March 2022 . theguardian.com . Guardian. https://web.archive.org/web/20240413152658/https://www.theguardian.com/society/2020/sep/22/nhs-to-hold-review-into-gender-identity-services-for-children-and-young-people. 13 April 2024.
  21. Book: Freeman . Hadley . Good Girls: A Story and Study of Anorexia . 2023 . Simon and Schuster . New York . 978-1-9821-8983-9 . 114–118 . https://books.google.com/books?id=kvi0EAAAQBAJ&pg=PA114 . en . 7. Mothers and the woman problem.
  22. News: Brooks . Libby . 10 March 2022 . NHS gender identity service for children can't cope with demand, review finds 10 March 2022 . live . https://web.archive.org/web/20220313002234/https://www.theguardian.com/society/2022/mar/10/nhs-gender-identity-service-for-children-cant-cope-with-demand-review-finds . 13 March 2022 . 13 March 2022 . The Guardian . Guardian.
  23. News: Bannerman . Lucy . 10 March 2022 . Tavistock gender clinic not safe for children, report finds . live . 29 March 2022 . The Times. https://web.archive.org/web/20240413153209/https://www.thetimes.co.uk/article/tavistock-gender-clinic-not-safe-for-children-report-finds-w0ngnjnnf. 13 April 2024. subscription.
  24. Dyer . Clare . Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review . BMJ . 9 April 2024 . 385 . q820 . 10.1136/bmj.q820 . en . 1756-1833.
  25. Dyer . Clare . NHS gender identity service to close and be replaced by regional centres . BMJ . 1 August 2022 . 378 . o1916 . 10.1136/bmj.o1916 . en . 1756-1833. subscription.
  26. Web site: Final Report – Cass Review . 19 April 2024 . cass.independent-review.uk.
  27. Web site: Gecsoyler . Sammy . Hilary Cass warned of threats to safety after ‘vile’ abuse over NHS gender services review. 20 April 2024 . theguardian.com . Guardian . 22 April 2024.
  28. Web site: 2024-05-08 . 'The evidence was disappointingly poor': The full interview with Dr. Hilary Cass . 2024-05-09 . www.wbur.org . en.
  29. News: Ghorayshi . Azeen . 2024-05-13 . Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine . 2024-05-14 . . en-US . 0362-4331.
  30. https://books.google.com/books?id=B4FtDgAAQBAJ&pg=PA226 Craft, p. 226
  31. News: 25 May 2012 . Five minutes with... Dr Hilary Cass, president, Royal College of Paediatrics . https://web.archive.org/web/20240412113323/https://www.theguardian.com/healthcare-network/2012/may/25/hilary-cass-royal-college-paediatrics . 12 April 2024 . 30 August 2015 . The Guardian.
  32. Web site: New Year's Honours lists 2015. 30 December 2014. 22 April 2024. Government of the United Kingdom: Cabinet Office and Foreign Office. PDF.
  33. News: 30 December 2014 . New year honours 2015: the full list . https://web.archive.org/web/20240413120849/https://www.theguardian.com/uk-news/2014/dec/30/-sp-new-years-honours-2015-full-list . 13 April 2024 . 30 August 2015 . The Guardian.
  34. Web site: Dissolution Peerages 2024 . 2024-07-04 . . en.
  35. News: Elgot . Jessica . 2024-07-04 . Sunak’s chief of staff and Theresa May among Tory peerages in dissolution honours . 2024-07-04 . . en-GB . 0261-3077.
  36. News: Sunak elevates Jewish doctor Hilary Cass to House of Lords in final act of premiership . Jane . Prinsley . . 2024-07-05 . 2024-07-27 .

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