A former nurse has lost her High Court legal challenge over the health watchdog's decision to register England's first private clinic offering gender treatment to young people. The ruling represents a significant victory for the Gender Plus Hormone Clinic in Birmingham, which has been operating since January last year.
Susan Evans and a mother known as XX took legal action against the Care Quality Commission (CQC) over its decision to register the clinic and allow it to prescribe cross-sex hormone treatment to 16 and 17-year-olds without conditions. The women argued the regulator had acted "irrationally" given the NHS's cautious stance following the Cass Review.
Court dismisses legal challenge
Mrs Justice Eady dismissed the claim on Thursday, ruling there was "no irrationality in the decisions reached" by the CQC. She said the watchdog's decisions fell within the "rational range" of options available to it.
The clinic, which was rated outstanding by the CQC last year, treats people aged 16 and older through prescribing gender-affirming hormones. However, in line with NHS policy, it does not prescribe puberty blockers to patients.
Cass Review recommendations cited
Lawyers for Evans and XX had argued the CQC failed to properly consider the Cass Review's recommendations for "extreme caution" when prescribing hormone treatment to 16 and 17-year-olds. The review, published by Baroness Cass in April last year, said there should be a "clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18".
The NHS has since opened three specialist children's gender clinics with plans for five more by the end of 2026. All hormone treatment recommendations must now be endorsed by a national multi-disciplinary team, which has not yet approved any hormone treatment for 16 and 17-year-olds since the Cass Review.
Private clinic's different approach
The Gender Plus Hormone Clinic was established by Dr Aidan Kelly and is led by nurse consultant Paul Carruthers, both former employees of the now-closed Tavistock Gender Identity Development Service. The clinic primarily treats patients aged between 16 and 25 using its own multi-disciplinary team.
Tom Cross KC, representing the challengers, argued there were "key differences" between the clinic's safeguards and NHS protections. He highlighted that referrals came from Dr Kelly's unregulated company, Kelly Psychology, which he said the CQC had "not factored in" properly.
CQC defends registration decision
Jamie Burton KC, for the CQC, said there was "ample evidence" that Kelly Psychology "did not pose an unacceptable risk" to patients. The court heard that a "significant number" of those assessed by the company were not referred for treatment at the clinic.
Peter Mant KC, representing the clinic, argued there was no legal requirement for private providers to mirror NHS care exactly. He said the clinic's model was "entirely consistent" with the Cass Review and NHS policy.
Clinic celebrates victory
In her 64-page ruling, Mrs Justice Eady concluded the CQC was entitled to find "sufficient alignment" between the clinic's practices and NHS standards. She said the regulator had properly considered the substance underpinning NHS structures rather than merely their form.
Dr Kelly said he was "absolutely delighted" at the judgment, with Carruthers stating that the ruling "further demonstrates the diligence and integrity of our work". The decision allows the clinic to continue operating without additional regulatory conditions.
(PA) Note: This article has been edited with the help of Artificial Intelligence.
