JK Rowling and Alan Bates are very different public figures, but perhaps they experienced similar feelings of vindication last week. A report by Dr Hilary Cass, a former president of the Royal College of Paediatrics, demolished some practices that were until recently prevalent in healthcare. Cass concluded that “for most young people, a medical pathway will not be the best way to manage their gender-related distress”. Bates, a former sub-postmaster who has spent the past 20 years pursuing the Post Office over its wrongful prosecution of more than 900 people, spent five hours in front of Sir Wyn Williams’s statutory inquiry. The ground is being prepared for the cross-examination next month of Paula Vennells, who was chief executive for much of the time in question. Bates followed his evidence by vowing to bring private prosecutions against the Post Office’s former bosses if necessary.
Like Rowling and Bates, NHS England’s gender identity development service (Gids) — now closed — and the Post Office ostensibly have little in common. Yet the scandals that engulf them have common features that tell us something about the way British institutions fail. The overwhelming problem afflicting both organisations was groupthink — a collective imbibing of flawed ideas, an inability to think objectively and critically and a refusal to engage with facts that appeared to contradict a consensus. In both cases the lives of vulnerable people were crushed under the wheels of a vehicle whose forward motion mattered more than anything to those in charge.
The Cass review was commissioned in 2020 amid growing concerns over the “gender-affirming” model adopted by the Gids clinic at the Tavistock and Portman specialist mental health trust in London. When Gids opened in 1989, it treated fewer than ten people a year, mostly males. By 2009 that had increased to about 50. By 2016 Gids was treating almost 1,800 young people. More than 1,000 were adolescent girls.
Rather than ask whether there might be other factors at play — such as mental health and body-image problems associated with social media and pornography — Gids followed a policy of prescribing puberty blockers and putting patients on a pathway to cross-sex hormones and eventually surgery. A Dutch study had suggested that puberty blockers might improve psychological wellbeing for a narrow group of children with gender-related problems. The use of these drugs was strongly advocated by the pressure groups Stonewall and Mermaids.
More than 9,000 people passed through the doors of Gids, but the clinic did not keep data on them. Six out of seven adult clinics would not co-operate with Cass’s review, a troubling indication of the struggles yet to come in rooting gender-affirming ideology out of the NHS. Cass rightly calls for more research into what she describes as the “complex interplay” between mental health issues and a young person’s desire to change gender. This will be a challenge, given the absence of records on the thousands who have undergone life-altering treatments.
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The Post Office scandal is a longer-running affair. Between 1999 and 2015, an estimated 4,000 branch owners, known as sub-postmasters, were accused of wrongdoing after faulty software supplied by the Japanese giant Fujitsu showed errors in their accounts. Four are known to have committed suicide. Many more died without clearing their names. But the management’s rejection of the possibility that the Horizon IT system was at fault was borne out by an email sent by Alan Cook, managing director of the Post Office between 2006 and 2010, in response to doubts about the technology. “My instincts tell me that, in a recession, subbies with their hand in the till choose to blame the technology when they are found to be short of cash,” he wrote.
Britain is a nation without a written constitution. There is something of the “good chap” principle that flows down into institutions such as the NHS and the Post Office. But this has been augmented by cowardice and a reluctance to confront fashionable orthodoxy for fear of losing face. When judgment goes badly and systemically awry, it can take a long time for the truth to come to light. One of the most depressing elements of both scandals is that they are still going on.
But it is also a function of our free society that concerned individuals such as Rowling and whistleblowers such as Bates can speak their mind. They should feel proud of the contribution they have made in tackling these twin tragedies. Others should heed their examples and see that, in the end, facts have a way of triumphing over lies.
