Challenge to the registration of a private gender healthcare clinic fails- Court of Appeal
19 December 2025
Alice Grant
In Evans v Care Quality Commission [2025] EWCA Civ 1556, the Court of Appeal (Lord Justice Lewis) refused to grant permission to appeal against the High Court’s dismissal of a judicial review challenging two decisions by the Care Quality Commission (“CQC”). The Appellants, Ms Evans and a mother who wished to remain anonymous, contested (1) the CQC’s January 2024 decision to register Gender Plus Healthcare Ltd (“GPH”) pursuant to section 12 of the Health and Social Care Act 2008 (“the 2008 Act”), and (2) the December 2024 review of GPH’s services under section 46 of the same Act.
The case has attracted substantial public interest, engaging broader debates over the regulation of cross-sex hormone treatment for minors. The widely-reported Cass Review, led by the British paediatrician Hilary Cass, together with concerns over the prevalence of ideological influences in this medical field, were raised.
Background
In the High Court, acknowledging the “strongly held views about this treatment”, Mrs Justice Eady observed (R (OAO Evans and another) v Care Quality Commission [2025] EWHC 2015 (Admin) at [2]):
“The hormone treatment in issue involves the prescription of masculinising or feminising hormones (oestrogen; testosterone), introducing irreversible changes to the patient’s body. There are strongly held views about this treatment and an expert panel is due to report to the Secretary of State for Health and Social Care on its use for those under 18. At present, however, the treatment provided by [GPH] to 16 and 17 year olds is permitted by law, and the issue I am required to determine is not whether that is correct, but whether specific decisions made by the CQC are irrational and/or unlawful.”
Despite agreeing with the Claimants (at [97]), who contended a higher standard of review applies to the irrationality challenge in this case since “hormone treatment is often sought by vulnerable and emotionally distressed individuals” and “can have significant, irreversible, long-term physical and psychological consequences,” the claim was dismissed at first instance.
Factual Background
Gender Plus Healthcare (“GPH”), founded by Dr Aidan Kelly in 2023, operates as a private provider of psychological and medical services for young people. Following referrals from Kelly Psychology, GPH offers cross-sex hormones (testosterone or oestrogen) to individuals aged 16 and over.
In December 2023, CQC’s assessment team, led by inspector Amy Robson, evaluated GPH’s application. The team consulted the interim Cass Review, NHS England guidance, and evidence from the former Tavistock GIDS clinic. Following internal review and oversight by senior CQC officers, GPH was registered on 9 January 2024, subject to a condition prohibiting treatment of under-16s.
Subsequent to registration, the Cass Review Final Report (April 2024) and the NHS’s March 2024 clinical commissioning policy reinforced the need for caution and national multidisciplinary oversight in prescribing cross-sex hormones to minors. CQC later conducted a detailed review of GPH’s operations between August and December 2024, directly observing consultations, interviewing staff and patients, and analysing compliance with NHS standards. The review rated GPH “outstanding.”
Grounds of Appeal
The Appellants advanced three grounds of appeal, all of which were rejected as having no realistic prospect of success.
Ground 1: Dr Kelly’s views as a relevant consideration
It was argued that the CQC erred by failing to consider Dr Kelly’s “strong personal or ideological views” on cross-sex hormone treatment as a legally relevant factor (at [22]). In particular, Dr Kelly’s critical stance of the Cass Review. Dr Kelly featured in the Guardian last year “I treat transgender children – banning puberty blockers is not a decision for politicians to make”, is a Director at Gender Plus and founder of a private clinic offering gender-related services to adolescents. He has been an outspoken critic of political and regulatory limits on cross-sex hormone treatment. The Appellants drew on AB v CD [2021] EWHC 741 (at [123]–[124]), where the Court had considered the risks of clinical bias in cross-sex hormone treatment decision-making.
Lewis LJ found no error (at [24]–[26]). Notably, the public interviews occurred after the January 2024 registration and thus could not have been considered in the assessment.
Ground 2: Failure to consider updated NHS policy
The second ground was that the CQC had failed to take account of up-to-date NHS policy, particularly the operation of national multi-disciplinary teams independent of referral clinics (at [27–[28]).
The Court rejected this (at [29]). Principally, the registration of the clinic predated policy changes, and by December 2024, the CQC had reviewed GPH against the March 2024 NHS commissioning policy.
Ground 3: Differences between GPH and NHS structures
The third ground alleged that the judge below had erred had treated substantive differences between GPH’s and NHS processes as “matters of form” rather than “substance” and that CQC was “required to recognise and grapple” with the fact that the relevant NHS processes contained safeguards which were said not to be present in the GPH processes (at [30]–[31]). The Appellants contended four alleged deficiencies, summarised below:
- Referrals of patients came from an unregulated entity (Kelly Psychology);
- Absence of mandatory medical practitioner review of patients prior to referral;
- Kelly Psychology and GPH were both founded and operated by Dr Kelly; and
- Differences in the composition of the multi-disciplinary team operated by GPH compared to the NHS’s multi-disciplinary teams.
Lewis LJ affirmed that all four factors were known and considered by the CQC (at [32]). Factors (2) and (4) arose after January 2024 and were therefore irrelevant to the registration decision. For the December 2024 assessment, the CQC had expressly compared GPH’s processes against NHS standards, concluding that GPH’s multidisciplinary review sufficiently met the regulatory objectives under the 2008 Act (at [32]–[24]).
Comment
The debate over cross-sex hormone treatment for minors remains scientifically contentious, with renewed scrutiny instigated by the Cass Review over the evidentiary and ethical foundations of this treatment. The Review concluded that the research base supporting medical transition in adolescence is “remarkably weak,” with limited follow-up data and significant uncertainty about long-term physical and psychological outcomes.
By contrast, the affirmative model, of which Dr Kelly is an adherent, prioritises self-declared identity and early medical intervention. Critics argue this risks bypassing the interplay of developmental, social, and psychological factors which often underpin adolescent decisions. From such a perspective, a safeguarding-led, evidence-based framework is essential to ensure that vulnerable young people are not channelled into irreversible medical pathways. The Cass Review, published last year, urged “extreme caution” in prescribing ‘puberty-blockers’ for under-18s. The claim brought by Ms. Evans, a former NHS nurse, and a mother in Evans v CQC thus comes at a time in which there is growing public demand for a robust scientific approach in a medical field where ideological pressures continue to weigh heavily.
