Transgender - Part 2

[Gethelred]

Please be aware that the tolerance of anti-trans language on BF is at an all-time low. Jokes and insults that are trans-related, as well as anti-trans and bigoted rhetoric will be met with infractions, threadbans etc as required. It's a sensitive (and important) topic, so behave like well-mannered adults when discussing it, PARTICULARLY when disagreeing. This equally applies across the whole site.

 

[Gralin]

I haven't dismissed any studies. Neither has the Cass Review, no matter how much activists want to spread false narratives that it did.

You sure about that?

 

[ShanDog]

You sure about that?

Quite. Happy to be shown evidence to the contrary (COUGH unlike some COUGH)

 

[Gralin]

Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review | Archives of Disease in Childhood

This was the study they commissioned that graded research.

The results of which don't actually match up with how they used them

 

[Gralin]

The Cass report also hasn't been peer reviewed
But hey policy is already being made based on it

 

[Gough]

The Cass report also hasn't been peer reviewed
But hey policy is already being made based on it

When you're bleeding votes to Reform, needs must.

 

[ShanDog]

The results of which don't actually match up with how they used them

Such as?

 

[Gralin]

Such as?

Such as the study didn't suggest that moderate quality research should be completely discounted

That was Cass

 

[ShanDog]

Such as the study didn't suggest that moderate quality research should be completely discounted

That was Cass

Once again, the Cass Report didn't discount studies rated as moderately strong at all. That's false. It didn't give them the same weight as the strong studies of course, because that's what a systematic review is supposed to do.

 

[ShanDog]

As noted by Ben Ryan in other tweets, the "They discounted 98 studies!" lie seems to originate with Alejandra Carballo, who has a record of dubious claims. It was also amplified by Michael Hobbs who is an outright imbecile.

 

[Gralin]

Once again, the Cass Report didn't discount studies rated as moderately strong at all. That's false. It didn't give them the same weight as the strong studies of course, because that's what a systematic review is supposed to do.

It drew it's conclusions as if they didn't exist.

 

[ShanDog]

It drew it's conclusions as if they didn't exist.

That's a lovely claim but not backed by any analysis I've seen. Again, happy for you to link to anyone's work that demonstrates this.

 

[swingdog]

So, does Cass really seek to bring the UK more into line with the Australian approach?

What implications does England’s review of trans healthcare have for Australia?

Australian experts defend ‘holistic, gender-affirming’ approach to gender-diverse care as very different from that of the NHS

www.theguardian.com

 

[CM86]

 

[CM86]

I think the Cass report disagreement is around terminology?

As in, it's not that they discounted the studies, but they discounted the results of the studies, based on the studies.

 

[ShanDog]

I think the Cass report disagreement is around terminology?

As in, it's not that they discounted the studies, but they discounted the results of the studies, based on the studies.

I think it's a bit more ignorant (or perhaps nefarious) than that.

A systematic review requires studies to be vetted for strength using a standardised scaling system. They are then placed in categories of relative strength and the review draws findings from them all with the relative weight of the studies in mind.

The Cass review didn't toss moderate or low strength studies out at all. Their findings and the trends they showed were discussed or reported on in a number of areas. The stronger studies were just discussed more and given more weight as you expect they should.

 

[CM86]

I think it's a bit more ignorant (or perhaps nefarious) than that.

A systematic review requires studies to be vetted for strength using a standardised scaling system. They are then placed in categories of relative strength and the review draws findings from them all with the relative weight of the studies in mind.

The Cass review didn't toss moderate or low strength studies out at all. Their findings and the trends they showed were discussed or reported on in a number of areas. The stronger studies were just discussed more and given more weight as you expect they should.

Can you help me understand some of the more clear reasons that a majority of studies were placed in a lower category?



Do you believe there should be a Government standardised scaling system on The Scientific Method?



As I said, It's not that the studies were discounted. It's that the results were discounted based on the studies. I think we agree on that?

 

[ShanDog]

Can you help me understand some of the more clear reasons that a majority of studies were placed in a lower category?



Do you believe there should be a Government standardised scaling system on The Scientific Method?



As I said, It's not that the studies were discounted. It's that the results were discounted based on the studies. I think we agree on that?

I've had a rare night on the sauce so I'm probably it much help to anyone, but worth pointing out that the categorisation method is not a government thing, it's a scientific scale. It's not perfect and might be done in a batter way but it's a standard method for grading the strength of papers.

Fro..what I understand, things that will affect the grading would be stuff like methodological rigour, sample sizes, availability of raw data etc. I can't remember the name of the scaling system but you can look it up. Might be helpful.

With regards to discounting - it depends what you mean. When you say discount, to me it means you simply ignore it. Disregard completely etc. but that's not what they did, they just didn't give as much weight to the findings of those studies compared to the higher ranked ones, which as I said, is what a systematic review is supposed to do - sort the wheat from the chaff and try to determine the strength of actual evidence.

 

[Gralin]

Yes but the methodology used for the review needs to be looked at

And the report weighting doesn't have to match the methodology just because they cite it

And that's part of the issue. The study I linked earlier didn't suggest that the research they graded as moderate was of low value but the Cass Report does act like it is.

The initial less release that came out with the report is where people are getting 98% of studies were discounted from.

The PR around this, the media reporting and the commentary from The UK government has been misrepresenting the report or highlighting the most negative parts

But the report itself was never commissioned to make things better, it was commissioned so they could do this.

Our Statement in Response to the Cass Review Report - The Kite Trust

A comprehensive review of NHS support for children experiencing gender-related distress was needed, and we welcome the fact the Cass Review team took on this task. The report acknowledges, and we agree, that the NHS has been failing trans children by not providing the timely and holistic support...

thekitetrust.org.uk

Interestingly it seems the is some disagreement with the the report is being used or interpreted from Dr Cass that certainly reads better than the outcomes government will enact in the name of the report

 

[CM86]

I've had a rare night on the sauce so I'm probably it much help to anyone, but worth pointing out that the categorisation method is not a government thing, it's a scientific scale. It's not perfect and might be done in a batter way but it's a standard method for grading the strength of papers.

Fro..what I understand, things that will affect the grading would be stuff like methodological rigour, sample sizes, availability of raw data etc. I can't remember the name of the scaling system but you can look it up. Might be helpful.

With regards to discounting - it depends what you mean. When you say discount, to me it means you simply ignore it. Disregard completely etc. but that's not what they did, they just didn't give as much weight to the findings of those studies compared to the higher ranked ones, which as I said, is what a systematic review is supposed to do - sort the wheat from the chaff and try to determine the strength of actual evidence.

Not a problem. No rush to reply and I hope you had a great night!


Can you give some examples from this case, so I can better understand the outcomes and your support for the report?

 

[EagleShore]

This is an incredibly vexed issue in our modern society. I get that. There are so many nuances here, and many strong feelings to boot, because for many of us, it is personal.


MY EXPERIENCE

Indeed it is somewhat personal to me. As a gay bloke, I recall a brief period in my youth (around age 8-9) during which on a few occasions when alone I would put a tea towel on my head and pretend to be a person with long hair (perhaps a girl?), admiring my reflection in the oven glass as if I had a beautiful mane of long hair. Around the same time, I recall that I would stand in the shower rubbing my abdomen (a brief period of only a month or so IIRC) and consider what it might be like to be pregnant (my brother's year 7 teacher at the time, Mrs Trautwein, was pregnant, so it was acutely in my mind).

I was a child.

I had not yet been through the essential stage of physical, emotional and sexual development we know as puberty.

My brain had also not yet fully developed.

When considering such a vexed issue, it behoves us ALL to understand the evidence. Some such evidence is held within the WPATH files and the Cass Review, along with hundreds (if not thousands) of case studies like mine (although mine was admittedly quite mild).


CURRENT CONCERNS

Despite the myriad issues contained within this realm, I must ask: How can most of you not understand what has truly been going on? Seriously...how can you all not be aware of the true complexity of this issue?


It is not simply "TRANS PEOPLE AND TRANS ACTIVISTS VS BIGOTS".


An ideology has become significantly influential in the realms of western governments (principally Canada, the US, the UK, NZ and Australia), corporations, mainstream media, universities and schools that encourages all gender non-conforming children to believe that they are actually transgender and (in the context of the US and UK at least) they have then been encouraged to possibly take puberty blockers, cross-sex hormones and in a certain percentage of cases, have gone on to have irreversible surgery that will remove their genitals and/or breasts without reliable evidence that this will improve their psychological health.

The degree to which TikTok and other social media have been involved in this phenomenon cannot be discounted. Rapid Onset Gender Dysphoria affecting adolescent females is of particular concern in this regard.

I am not against transgender individuals.

But I am for the CORRECT DIAGNOSIS of all individuals presenting to gender services, INCLUDING transgender individuals.

ENOUGH WITH THE RETORTS OF TRANSPHOBIA...some people, indeed many well-informed people and medical professionals, simply have concerns surrounding the recent trends in medicine vis-a-vis the aspects and consequences of gender ideology and more specifically, the model of gender-affirming care.

There are absolutely transgender individuals in society. This DOES NOT mean, however, that in the past decade a significant proportion of young people presenting with gender dysphoria (aka gender non-conforming youth) are actually not, in fact, transgender people.

I will reiterate here that I am FOR THE CORRECT DIAGNOSIS of all individuals presenting to gender services with gender non-conformity as either:

A) Transgender individuals; and/or
B) Autistic individuals; and/or
C) Gay/lesbian (same sex attracted - let them live through puberty to discover this, and beforehand, engage with a line of inquiry in order to predetermine the likelihood of this being the case - I, for instance, was more inclined to look at the men's underwear models in the local KMart catalogue than the women at the age of around 8-9 even though I had no idea this was a signifier of future homosexuality); and/or
D) Abused or otherwise traumatised individuals...

...such that an appropriate course of psychotherapy and treatment may ensue.

All of those individuals would benefit from a degree of psychotherapy (from mild to intensive depending upon the degree of distress) along with a "watchful waiting" approach, instead of being so readily and, in a majority of cases, ERRONEOUSLY diagnosed as transgender, which may lead to, and indeed has led to, the treatment for a condition which does not exist in most such individuals.


ISSUES EMANATING FROM THE CURRENT PREDICAMENT

The Hippocratic oath is founded upon the following:

PRIMUM NON NOCERE (= FIRST, DO NO HARM).

The diagnosis MUST BE ACCURATE, lest you apply inappropriate treatments to incorrectly diagnosed individuals and hence cause harm to those individuals.

I regard here that, specifically, kirsti would most likely have indeed been diagnosed as (A), a transgender individual, even considering that I do not know her. All power to you, Kirsti, and I sincerely wish you nothing but the best in your life, which has likely been at least slightly more difficult in a variety of ways than the majority of posters here on BigFooty. I hope you are well and happy. From my albeit scant reading of this thread (I have been away from BigFooty for a few years now), I am confident that you are strong enough intellectually and emotionally to understand that what I present here is in no way a denigration of your experience or indeed of any transgender individuals in our society. I am glad that we have your perspective available in this thread, and indeed invite your input in response to my post here (no pressure or course ).

In a similar regard, it is important to note that EVIDENCE SUGGESTS THAT 70-85% of gender non-conforming pre-pubescent youth will simply END UP TO BECOME GAY OR LESBIAN adults. Obviously, I fell into this category.

It is incumbent on all people involved in this debate to acknowledge that the treatments for Transgender people (specifically, puberty blockers, cross-sex hormones, and gender-transition surgeries) involve the risk of harm (pain, bone density reduction, increase in ovarian or testicular cancer risk, further psychological trauma, hormone-related changes to mood and body physiology, and the possibility of sterilisation and anorgasmia in future adulthood).

The issue at hand lies with delineating people in item (A) above from those who are more accurately defined as belonging in items (B) to (D). Accurately diagnosing an individual as Transgender requires a period of time to eliminate all of the other causes of gender non-conformity (B through to D and/or others not listed). It is important to note here that I am not across the current diagnostic process here in Australia...although I have firsthand knowledge from an acquaintance (medical doctor in Australia who is one of those imbued with the ability to treat and/or advise on the treatment of gender dysphoric individuals) that we in Australia adhered to the gender-affirming model at the time of December 2022.

Young people who have presented to GPs or other medical services with gender dysphoria have presented with what is known in the medical fraternity as a DIAGNOSTIC PROBLEM.

The gender-affirming model, while well-intentioned (as much as I am CERTAIN THAT ALL OF YOU GUYS ARE WELL-INTENTIONED WITH YOUR VIEWS), is problematic and hence dangerous in terms of the real risk of rendering certain medical and surgical treatments to incorrectly diagnosed individuals, simply because it circumvents a more detailed diagnostic process that should consider all of the nuances pertaining to the individual at hand.

If the diagnosis is incorrect, we find that a significant proportion of people presenting with gender dysphoria end up having the wrong treatment.

In lieu of this model, I espouse the benefits of a more intensive psychological approach in which all possible factors leading to the presentation of the individual with gender dysphoria are deeply explored.


MODERN SITUATION

What has happened in the last 5-8 years is that more gender dysphoric people have been diagnosed as transgender as a result of:

A) A change ABSENT OF EVIDENCE to the medical protocols of diagnosis of transgender FROM an intensive psychological assessment and exploration of all factors likely at play in the individuals' presentation for medical assessment for gender dysphoria TO an exclusively gender-affirming model; combined with
B) An obvious, self-evident, "burying your head in the sand if you deny it" social media driven expansion of gender ideology, noted primarily by the ever-present trans and non-binary gender identities featuring on social media along with the non-evidence based espousal by institutions such as the BBC that there are a multitude, hundreds even, of other "neo-genders".


CONCLUSIONS

We should defer to the evidence. All streams of modern medicine do so. Indeed it has struck many professionals and otherwise concerned individuals that in this realm alone doctors have not relied upon a solid evidence base before making decisions for their patients that involve significant, and in may cases, irreversible treatments.

The WPATH files and the Cass Review have provided at least some level of evidence amid what was otherwise simply a sociological phenomenon absent such data.


Labelling those such as myself who hold legitimate concerns about the recent gender-affirming only model as transphobic, or as otherwise bigoted, is short-sighted, irrational, or indeed otherwise in conflict with the supposed views by those casting such dispersions, by which I mean, in my opinion, it is incredibly homophobic and bigoted to assert anything BUT concern for this model.


In other words, I contend that people who refuse to either look at the evidence, or at least consider the inherent complexities in such an issue, are homophobic.

Gay blokes like myself may have been told we were trans and encouraged through what would have ultimately been an erroneous path of transition involving significant harm should the modern medical and social milieu have been present in the 1990s.

This is not to say that a small proportion of people - those who are actually transgender - would not benefit from such intervention, albeit considered and applied with an ethic underpinned by "First, do no harm". This is THE diagnostic dilemma for the best informed and most evidence based practitioners alone, something which the practitioners at the now closed Tavistock Clinic in the UK were not. Remember, it was a subset of those clinicians who blew the proverbial whistle in the first place.

To this end, the evidence contained within the WPATH files and the Cass Review should not be summarily dismissed by anyone, especially those with a vested interest in the health and safety of our youth.


All the best to all concerned. Sincerely,

EagleShore.

 

[CM86]

This is an incredibly vexed issue in our modern society. I get that. There are so many nuances here, and many strong feelings to boot, because for many of us, it is personal.


MY EXPERIENCE

Indeed it is somewhat personal to me. As a gay bloke, I recall a brief period in my youth (around age 8-9) during which on a few occasions when alone I would put a tea towel on my head and pretend to be a person with long hair (perhaps a girl?), admiring my reflection in the oven glass as if I had a beautiful mane of long hair. Around the same time, I recall that I would stand in the shower rubbing my abdomen (a brief period of only a month or so IIRC) and consider what it might be like to be pregnant (my brother's year 7 teacher at the time, Mrs Trautwein, was pregnant, so it was acutely in my mind).

I was a child.

I had not yet been through the essential stage of physical, emotional and sexual development we know as puberty.

My brain had also not yet fully developed.

When considering such a vexed issue, it behoves us ALL to understand the evidence. Some such evidence is held within the WPATH files along with the Cass Review, along with hundreds (if not thousands) of case studies like mine (although mine was admittedly quite mild).


CURRENT CONCERNS

Despite the myriad issues contained within this realm, I must ask: How can most of you not understand what has truly been going on? Seriously...how can you all not be aware of the true complexity of this issue?


It is not simply "TRANS PEOPLE AND TRANS ACTIVISTS VS BIGOTS".


An ideology has become significantly influential in the realms of western governments (principally Canada, the US, the UK, NZ and Australia), corporations, mainstream media, universities and schools that encourages all gender non-conforming children to believe that they are actually transgender and (in the context of the US and UK at least) they have then been encouraged to possibly take puberty blockers, cross-sex hormones and in a certain percentage of cases, have gone on to have irreversible surgery that will remove their genitals and/or breasts without reliable evidence that this will improve their psychological health.

The degree to which TikTok and other social media have been involved in this phenomenon cannot be discounted. Rapid Onset Gender Dysphoria affecting adolescent females is of particular concern in this regard.

I am not against transgender individuals.

But I am for the CORRECT DIAGNOSIS of all individuals presenting to gender services, INCLUDING transgender individuals.

ENOUGH WITH THE RETORTS OF TRANSPHOBIA...some people, indeed many well-informed people and medical professionals, simply have concerns surrounding the recent trends in medicine vis-a-vis the aspects and consequences of gender ideology and more specifically, the model of gender-affirming care.

There are absolutely transgender individuals in society. This DOES NOT mean, however, that in the past decade a significant proportion of young people presenting with gender dysphoria (aka gender non-conforming youth) are actually not, in fact, transgender people.

I will reiterate here that I am FOR THE CORRECT DIAGNOSIS of all individuals presenting to gender services with gender non-conformity as either:

A) Transgender individuals; and/or
B) Autistic individuals; and/or
C) Gay/lesbian (same sex attracted - let them live through puberty to discover this, and beforehand, engage with a line of inquiry in order to predetermine the likelihood of this being the case - I, for instance, was more inclined to look at the men's underwear models in the local KMart catalogue than the women at the age of around 8-9 even though I had no idea this was a signifier of future homosexuality); and/or
D) Abused or otherwise traumatised individuals...

...such that an appropriate course of psychotherapy and treatment may ensue.

All of those individuals would benefit from a degree of psychotherapy (from mild to intensive depending upon the degree of distress) along with a "watchful waiting" approach, instead of being so readily and, in a majority of cases, ERRONEOUSLY diagnosed as transgender, which may lead to, and indeed has led to, the treatment for a condition which does not exist in most such individuals.


ISSUES EMANATING FROM THE CURRENT PREDICAMENT

The Hippocratic oath is founded upon the following:

PRIMUM NON NOCERE (= FIRST, DO NO HARM).

The diagnosis MUST BE ACCURATE, lest you apply inappropriate treatments to incorrectly diagnosed individuals and hence cause harm to those individuals.

I regard here that, specifically, kirsti would most likely have indeed be diagnosed as (A), a legitimately transgender individual, even considering that I do not know her. All power to you, Kirsti, and I sincerely wish you nothing but the best in your life, which has likely been at least slightly more difficult in a variety of ways than the majority of posters here on BigFooty. I hope you are well and happy, and that you are strong enough intellectually to understand that what I present here is in no way a denigration of your experience or indeed of any transgender individuals in our society.

In a similar regard, it is important to note that EVIDENCE SUGGESTS THAT 70-85% of gender non-conforming pre-pubescent youth will simply END UP TO BECOME GAY OR LESBIAN adults. Obviously, I fell into this category.

It is incumbent on all people involved in this debate to acknowledge that the treatments for Transgender people (specifically, puberty blockers, cross-sex hormones, and gender-transition surgeries) involve the risk of harm (pain, bone density reduction, increase in ovarian or testicular cancer risk, further psychological trauma, hormone-related changes to mood and body physiology, and the possibility of sterilisation and anorgasmia in future adulthood).

The issue at hand lies with delineating people in item (A) above from those who are more accurately defined as belonging in items (B) to (D). Accurately diagnosing an individual as Transgender requires a period of time to eliminate all of the other causes of gender non-conformity (B through to D and/or others not listed). It is important to note here that I am not across the current diagnostic process here in Australia...although I have firsthand knowledge from an acquaintance (medical doctor in Australia who is one of those imbued with the ability to treat and/or advise on the treatment of gender dysphoric individuals) that we in Australia adhered to the gender-affirming model at the time of December 2022.

Young people who have presented to GPs or other medical services with gender dysphoria have presented with what is known in the medical fraternity as a DIAGNOSTIC PROBLEM.

The gender-affirming model, while well-intentioned (as much as I am CERTAIN THAT ALL OF YOU GUYS ARE WELL-INTENTIONED WITH YOUR VIEWS), is problematic and hence dangerous in terms of the real risk of rendering certain medical and surgical treatments to incorrectly diagnosed individuals, simply because it circumvents a more detailed diagnostic process that should consider all of the nuances pertaining to the individual at hand.

If the diagnosis is incorrect, we find that a significant proportion of people presenting with gender dysphoria end up having the wrong treatment.

In lieu of this model, I espouse the benefits of a more intensive psychological approach in which all possible factors leading to the presentation of the individual with gender dysphoria are deeply explored.


MODERN SITUATION

What has happened in the last 5-8 years is that more gender dysphoric people have been diagnosed as transgender as a result of:

A) A change ABSENT OF EVIDENCE to the medical protocols of diagnosis of transgender FROM an intensive psychological assessment and exploration of all factors likely at play in the individuals' presentation for medical assessment for gender dysphoria TO an exclusively gender-affirming model; combined with
B) An obvious, self-evident, "burying your head in the sand if you deny it" social media driven expansion of gender ideology, noted primarily by the ever-present trans and non-binary gender identities featuring on social media along with the non-evidence based espousal by institutions such as the BBC that there are a multitude, hundreds even, of other "neo-genders".


CONCLUSIONS

We should defer to the evidence. All streams of modern medicine do so. Indeed it has struck many professionals and otherwise concerned individuals that in this realm alone doctors have not relied upon a solid evidence base before making decisions for their patients that involve significant, and in may cases, irreversible treatments.

The WPATH files and the Cass Review have provided at least some level of evidence amid what was otherwise simply a sociological phenomenon absent such data.


Labelling those such as myself who hold legitimate concerns about the recent gender-affirming only model as transphobic, or as otherwise bigoted, is short-sighted, irrational, or indeed otherwise in conflict with the supposed views by those casting such dispersions, by which I mean, in my opinion, it is incredibly homophobic and bigoted to assert anything BUT concern for this model.


In other words, I contend that people who refuse to look at the evidence, or even at least consider the inherent complexities in such an issue, are homophobic, based upon the available evidence.

Gay blokes like myself may have been told we were trans and encouraged through what would have ultimately been an erroneous path of transition involving significant harm should the modern medical and social milieu have been present in the 1990s.

This is not to say that a small proportion of people - those who are actually transgender - would not benefit from such intervention, albeit considered and applied with an ethic underpinned by "First, do no harm". This is THE diagnostic dilemma for the best informed and most evidence based practitioners alone, something which the practitioners at the now closed Tavistock Clinic in the UK were not. Remember, it was a subset of those clinicians who blew the proverbial whistle in the first place.

To this end, the evidence contained within the WPATH files and the Cass Review should not be summarily dismissed by anyone, especially those with a vested interest in the health and safety of our youth.


All the best to all concerned. Sincerely,

EagleShore.

I really appreciate your post. Thank you for posting.



Can I ask you what you believe the "gender-affirming model" is?
Do you believe that if you'd been born in 2000-10s that you'd be pushed into changing your gender based on your sexual orientation?
Do you believe that teaching children about gender and homosexuality is a positive or dangerous thing?

 

[Gralin]

 

[Chief]

Good coverage of the Cass side of the argument here:



Odd that they called it "internet rumours" without getting a balancing argument from groups with issues with Cass. To my ears it was presented as either Cass or "internet rumours".

Then again it's just a statistics podcast.

 

[faible]

encourages all gender non-conforming children to believe that they are actually transgender

I'm intrigued whether there's any source for this.

Seems like a pretty big claim to me.

Also other parts of your post seem to imply that they're simply pushed / offered / given puberty blockers (or other hormones) without any consultation with a psychologist, and indeed, that it's an ideological push from those in the medical industry to get them on to puberty blockers ASAP.

 

[Chief]

I'm intrigued whether there's any source for this.

Seems like a pretty big claim to me.

Also other parts of your post seem to imply that they're simply pushed / offered / given puberty blockers (or other hormones) without any consultation with a psychologist, and indeed, that it's an ideological push from those in the medical industry to get them on to puberty blockers ASAP.

Yes I appreciate the effort to respond in detail, but some of the detail doesn't match with the experience of friends and their children.

It takes a few years of preparation and counselling. Kids who have thoughts about being the opposite gender aren't nabbed off the street by Antifa and "transed".

I believe that due to lack of resources in the NHS it wasn't as thorough in some instances. So of course the Tories cut all resources because of "the scandal".

The Tory way. Cut funding (recently by taking doctors pay rises out of capital budgets) until it's broken, then close it down and give a fat contract to a mate to run it.

If Cass results in proper resourcing then of course that's great.