UK Department of Health and Social Care and transgender people

The Department of Health and Social Care (DHSC) is the UK government ministry responsible for health and adult social care policy in England. Since 2024, DHSC has made the UK’s most significant government-level decisions on trans healthcare, including an indefinite ban on puberty blockers for young people.

It funds and oversees the National Health Service (NHS) in England and sponsors several public bodies that shape transgender healthcare, including NICE (the National Institute for Health and Care Excellence), the Medicines and Healthcare products Regulatory Agency (MHRA) and the Health Research Authority (HRA). NHS commissioned the anti-trans Cass Review and NICE reports. Its research funder, the National Institute for Health and Care Research (NIHR), is funding the PATHWAYS puberty blocker trial.

NHS England, which commissions specialist gender services, is being abolished and folded into DHSC. The government aims to complete that by April 2027.

Background

The department has existed under several names: the Ministry of Health (1919), the Department of Health and Social Security (1968), the Department of Health (1988). DHSC took its current name in 2018. DHSC’s NHS responsibilities cover England, while Scotland, Wales and Northern Ireland run their own health services.

NHS care for trans people predates any formal departmental policy. The Gender Identity Clinic at Charing Cross Hospital in London, founded in 1966, is the oldest and largest in the UK. It was founded by psychiatrist John Randell under a strict gatekeeping model of care. Randell approved only 10% to 15% of those seeking surgery. After Randell died in 1982, key figures included Donald Montgomery and Richard Green.

In 1989, child and adolescent psychiatrist Domenico Di Ceglie founded a small clinic for young people at St George’s Hospital in London. It moved to the Tavistock and Portman NHS Foundation Trust in 1994 as the Gender Identity Development Service (GIDS), and became a nationally commissioned NHS service in 2009.

Policy working group and NICE reviews

In 2020, NHS England commissioned pediatrician Hilary Cass to chair a policy working group to review the evidence on puberty blockers and cross-sex hormones for trans and gender diverse young people, and whether its clinical policies on these interventions should change. NHS England also asked NICE to develop guidance on the appropriate ages to refer children to specialist services. Cass was later appointed to lead the Cass Review, an independent review of gender identity services for children and young people. NHS England also commissioned NICE to review the evidence on puberty blockers and cross-sex hormones for trans and gender diverse minors. The reviews were commissioned to inform Cass’s working group. The NICE reviews influenced the Cass Review and NHS England’s subsequent restrictions on these treatments.

In 2022, Cass published an interim report used as a pretext to close the GIDS program at Tavistock and Portman. In 2024, Cass published a final report that was used as a pretext to restrict trans healthcare for minors even further.

Puberty blocker ban

In March 2024, NHS England stopped routine NHS prescribing of puberty blockers. In May 2024, weeks after the Cass Review final report, Atkins used emergency powers under the Medicines Act 1968 to ban the sale and supply of puberty blockers to trans and gender diverse minors by private prescribers, including those based in Europe or Switzerland.

Trans rights group TransActual and an anonymous young person challenged the ban, with the campaign group Good Law Project coordinating the claim. The claimants argued that Atkins had overridden officials’ advice. On July 29, 2024, the High Court upheld the ban as lawful.

After the July 2024 general election, Wes Streeting kept the ban and extended it twice. On December 11, 2024, acting on advice from the Commission on Human Medicines that claimed continued prescribing posed “an unacceptable safety risk,” Streeting made the ban indefinite from January 1, 2025, with a first review in 2027. The ban also covers Northern Ireland, whose executive agreed to it the day before. Young people already receiving puberty blockers through the NHS could continue, and breaching the order became a criminal offense. The government’s consultation document cited the 2020 NICE evidence reviews as part of the evidence base.

PATHWAYS trial

In 2025, the NHS announced tightly controlled clinical trials for puberty blockers, to be managed by the Children and Young People’s Gender Dysphoria Research Oversight Board. Camilla Kingdon was named chair of the board, and Cass was named as an advisor. Michael Absoud was named Joint Lead Applicant for the puberty blocker clinical trial.

In 2024, Absoud presented on “Autism spectrum disorders and gender dysphoria and adolescents” at the Athens conference held by anti-trans hate group Society for Evidence-Based Gender Medicine. It was revealed in 2025 through a Freedom of Information request that as part of their communications and engagement strategy (page 15), members were considering conferences by anti-trans groups “for possible clinician participation,” including:

• Society for Evidence-Based Gender Medicine (SEGM )
• Clinical Advisory Network on Sex and Gender (CAN-SG)

In the summer of 2025, SEGM helped organize five symposia at the European Society for Child and Adolescent Psychiatry (ESCAP) conference in Strasbourg, France, in collaboration with the ESCAP Policy Division. Absoud and Emily Simonoff presented on “Programmatic research on Gender Incongruence in England and Wales.”

Following the Cass Review’s recommendation, the government backed a clinical trial of puberty blockers. PATHWAYS (Puberty suppression And Transitional Healthcare with Adaptive Youth Services) is run by King’s College London and funded by the NIHR at a cost of about £10 million. It received ethics and regulatory approval in November 2025.

In January 2026, Jacob George was named Chief Medical and Scientific Officer (CMSO) at the Medicines and Healthcare products Regulatory Agency (MHRA). One of George’s first actions was to pause the PATHWAYS clinical trial for use of puberty blockers in gender diverse youth. On February 20, 2026, DHSC announced the trial was paused after the MHRA raised new safety concerns, including a recommended minimum age of 14. Because the trial was the only remaining NHS route to puberty blockers for new patients, the pause left them unavailable through the NHS. In February 2026, George was removed from involvement in the PATHWAYS trial after Times Radio presenter Cathy Newman reported multiple instances of anti-trans sentiment on George’s social media. 

The MHRA later cleared the trial to continue with a minimum age requirement and strengthened patient information. Legal proceedings delayed recruitment until at least August 1, 2026. WPATH, EPATH and USPATH raised concerns about informed consent in the trial. Anti-trans activists opposed running the trial at all. Anti-trans hate group Genspect launched the Protecting Puberty petition, and Bayswater Support Group sent a legal threat.

Sex-segregated hospital wards

After the Supreme Court ruled in For Women Scotland v. The Scottish Ministers (April 16, 2025) that “sex” in the Equality Act 2010 means biological sex, Streeting said the NHS would provide sex-segregated wards “based on biology,” along with private rooms for trans patients. NHS England published the guidance on October 15, 2026, 18 months later. It requires sex-segregated wards, toilets, and changing rooms to be allocated by biological sex rather than gender identity. An internal NHS England impact assessment warned the change could cause delays and more “corridor care” for trans patients. Opposition parties criticized the delay, while trans advocates criticized the policy itself.

Adult and hormone services

In December 2025, NHS England published a review of adult gender clinics, led by David Levy. In 2026, they announced a pause on new hormone prescriptions for 16- and 17-year-olds. NHS England also undertook an evidence review for hormones in adults, with a consultation expected in late 2026. These responsibilities will pass directly to DHSC when NHS England is abolished.

People

Secretaries of State immediately before and since the Cass Review began:

• Jeremy Hunt (Conservative): September 2012 to July 2018
• Matt Hancock (Conservative): July 2018 to June 2021
• Sajid Javid (Conservative): June 2021 to July 2022
• Steve Barclay (Conservative): July to September 2022 (first term)
• Thérèse Coffey (Conservative): September to October 2022
• Steve Barclay (Conservative): October 2022 to November 2023 (second term)
• Victoria Atkins (Conservative): November 2023 to July 2024
• Wes Streeting (Labour), July 2024 to May 2026
• James Murray (Labour), May to July 2026
• Yvette Cooper (Labour), appointed July 2026

References

Cugini, Eli (October 26, 2026). New NHS rules disguise deliberate mistreatment as common sense. Xtra https://xtramagazine.com/power/politics/nhs-guidance-uk-anti-trans-hospitals-285160

British Medical Association (October 21, 2026). STATEMENT: NHS guidance on the provision of single-sex services and facilities. https://www.bma.org.uk/news-and-opinion/statement-nhs-guidance-on-the-provision-of-single-sex-services-and-facilities

Thompson, Sian (October 19, 2026). NHS England’s trans ward policy could increase risk of ‘corridor care’, report finds. PinkNews https://www.thepinknews.com/2026/10/19/nhs-guidance-trans-impact-report-single-sex-wards/

Staff report (October 15, 2026). New NHS guidance confirms exclusion of trans women patients from female wards. ITV News https://www.itv.com/news/2026-10-15/new-nhs-guidance-confirms-exclusion-of-trans-women-patients-from-female-wards

Staff report (October 5, 2026). Experts escalate concerns over NHS England’s evidence reviews of gender-affirming care. TransActual https://transactual.org.uk/blog/2026/10/05/experts-escalate-concerns-over-nhs-englands-evidence-reviews-of-gender-affirming-care/

Equality and Human Rights Commission (August 5, 2026). Equality Act 2010: Code of Practice for services, public functions and associations, 2026. https://www.gov.uk/government/publications/equality-act-2010-code-of-practice-for-services-public-functions-and-associations-2026/equality-act-2010-draft-code-of-practice-for-services-public-functions-and-associations-2026

Beaney, Abigail (June 22, 2026). MHRA clears PATHWAYS puberty blocker trial to continue. Clinical Trials Arena https://www.clinicaltrialsarena.com/?p=255187

Gavin, Rowan (May 9, 2026). DHSC escalates opposition to puberty blockers for Trans+ kids, calling their use “appalling.” QueerAF https://www.wearequeeraf.com/dhsc-escalates-opposition-to-puberty-blockers-for-trans-kids-calling-their-use-appalling/

Smallens, Yasemin (March 12, 2026). NHS England Blocks Access to Gender-Affirming Hormone Therapies. Human Rights Watch https://www.hrw.org/news/2026/03/12/nhs-england-blocks-access-to-gender-affirming-hormone-therapies

Staff report (March 10, 2026). NHS England to conduct ‘evidence review’ into HRT for trans adults. PinkNews https://www.thepinknews.com/2026/03/10/nhs-england-clinical-evidence-review/

Hansford, Amelia (February 25, 2026). Puberty blockers now completely inaccessible for trans youth after NHS trial paused. PinkNews https://www.thepinknews.com/2026/02/25/puberty-blockers-now-completely-inaccessible-for-trans-youth-after-nhs-trial-paused/

Burns, Corrinne (December 16, 2024). Ban on puberty blockers in the UK made indefinite, government says. The Pharmaceutical Journal https://pharmaceutical-journal.com/article/news/ban-on-puberty-blockers-in-the-uk-made-indefinite

Staff report (December 12, 2024). UK confirms “indefinite” ban on puberty blockers. GCN https://gcn.ie/?p=197228

Staff report (April 30, 2024). Biological sex ‘must be respected’ in NHS, says Health Secretary. Guernsey Press https://guernseypress.com/news/uk-news/2024/04/30/biological-sex-must-be-respected-in-nhs-says-health-secretary/ [archive]

NHS (May 16, 2008). Guidance for GPs, other clinicians and health professionals on the care of gender variant people. https://data.parliament.uk/DepositedPapers/Files/DEP2008-2595/DEP2008-2595.pdf

Staff report (August 29, 2014). Department of Health literature project. Gender Identity Research and Education Society https://www.gires.org.uk/?p=1207

Anti-trans coverage

Murray, Jessica (October 15, 2026). Trans women no longer to be placed on female-only wards under new NHS England guidance. The Guardian https://www.theguardian.com/society/2026/oct/15/trans-women-no-longer-to-be-placed-on-female-only-wards-under-new-nhs-england-guidance

Holt, Alison; Melley, James (August 5, 2026). New guidance on single-sex spaces comes into force. BBC News https://www.bbc.com/news/articles/c9983lv4dlno

Barnes, Hannah (March 20, 2024). Inside the collapse of the Tavistock Centre. New Statesman https://www.newstatesman.com/?p=445228

Dyer, Clare (August 7, 1999). Blanket ban on treating transsexuals is ruled “unlawful.” BMJ 319(7206), 338–338. https://doi.org/10.1136/bmj.319.7206.338a

Selected government publications

Staff report (June 19, 2026). An update on the PATHWAYS trial. Health Research Authority https://www.hra.nhs.uk/about-us/news-updates/an-update-on-the-pathways-trial

Staff report (May 18, 2026). What’s in the new Health Bill? Nuffield Trust https://www.nuffieldtrust.org.uk/resource/whats-in-the-new-health-bill

House of Commons Library (March 19, 2026). Hormone treatments for children and young people: Clinical trial and consultations. https://commonslibrary.parliament.uk/research-briefings/cbp-10596/

Department of Health and Social Care (February 20, 2026). PATHWAYS clinical trial paused following new MHRA advice. GOV.UK https://www.gov.uk/government/news/pathways-clinical-trial-paused-following-new-mhra-advice

NHS England (December 18, 2025). Operational and delivery review of NHS adult gender dysphoria clinics in England. https://www.england.nhs.uk/publication/operational-and-delivery-review-of-nhs-adult-gender-dysphoria-clinics-in-england/

Department of Health and Social Care (December 11, 2024). Ban on puberty blockers to be made indefinite on experts’ advice. https://www.gov.uk/government/news/ban-on-puberty-blockers-to-be-made-indefinite-on-experts-advice

Department of Health and Social Care (December 11, 2024). Proposed changes to the availability of puberty blockers for under-18s. https://www.gov.uk/government/consultations/proposed-changes-to-the-availability-of-puberty-blockers-for-under-18s/proposed-changes-to-the-availability-of-puberty-blockers

Department of Health and Social Care (April 29, 2024). NHS Constitution plans to strengthen privacy, dignity and safety. GOV.UK https://www.gov.uk/government/news/nhs-constitution-plans-to-strengthen-privacy-dignity-and-safety

Atkins, Victoria (April 29, 2024). Letter to Steve Brine, Chair, Health and Social Care Select Committee. UK Parliament https://committees.parliament.uk/publications/44694/documents/221980/default/

Department of Health (October 2008). Trans: A practical guide for the NHS. https://data.parliament.uk/DepositedPapers/Files/DEP2012-0096/DEP2012-0096.pdf

Tavistock and Portman NHS Foundation Trust (November 6, 2019). FOI 19-20071: The date that ‘sex changes’ began. [FOI request] https://tavistockandportman.nhs.uk/wp-content/uploads/2023/10/FOI_19-20071_The_Date_that_Sex_Changes_Began.pdf [archive]

Media

Department of Health and Social Care (December 12, 2024). IN FULL: Watch Health Secretary Wes Streeting Confirm Indefinite Puberty Blockers Ban. https://www.youtube.com/watch?v=E6li0z0hm6Y

Department of Health and Social Care (April 16, 2024). IN FULL: Watch Health Secretary Victoria Atkins’s statement on the Cass Review in Parliament. https://www.youtube.com/watch?v=H9c118CAsOU

Resources

GOV.UK (gov.uk)

• Department of Health an Social Care
• gov.uk/government/organisations/department-of-health-and-social-care

Wikipedia (en.wikipedia.org)

• Department of Health and Social Care