RDS and Bayswater Support Group -v- Secretary of State for Health and Social Care (anonymity order)
Case number: AC-2026-LON-002515
In the High Court of Justice
King’s Bench Division
Administrative Court
In the matter of an application for judicial review
17 July 2026
Before:
The Hon. Mr Justice Sheldon
Between:
The King
on the application of
(1) RDS
(2) Bayswater Support Group
(Claimants)
-v-
Secretary of State for Health and Social Care
(Defendant)
and
NHS England
(Interested Party)
Order
Notification of the Judge’s Decision (CPR 54.11, 54.12)
Following consideration of the documents lodged by the Claimant, the Defendant’s Summary Grounds of Defence and the Claimant’s Reply
ORDER BY THE HON. Mr Justice Sheldon
(1) Anonymity
a. Pursuant to CPR 39.2(4) and s. 6 of the Human Rights Act 1998:
i. the names of the First Claimant, his children and his former spouse are to be withheld from the public and must not be disclosed in any proceedings in public;
ii. the name of the chair of the Second Claimant, her children and any partner are to be withheld from the public and must not be disclosed in any proceedings in public.
iii. the First Claimant and chair of the Second Claimant are to be referred to orally and in writing as ‘RDS’ and ‘RDA’ respectively.
iv. The First Claimant and Chair of the Second Claimant are permitted to use ‘care of’ (c/o) addresses of the Claimants’ solicitors in the claim form and on any witness statements filed.
b. Pursuant to s. 11 of the Contempt of Court Act 1981, there must be no publication of the identity of the First Claimant or Chair of the Second Claimant, or of any matter likely to lead to the identification of any of them, in any report of, or otherwise in connection with, these proceedings.
c. Pursuant to CPR 5.4C(4):
i. the parties must within 7 days file a redacted copy of any statement of case filed, omitting the name, address and any other information likely to lead to the identification of the said Claimants or any of the other individuals referred to in (a)(i) or (ii);
ii. if any statement of case subsequently filed includes information likely to lead to the identification of the Claimants or to the identification of any of the other individuals referred to in (a)(i) or (ii), a redacted copy omitting that information must be filed at the same time;
iii. unless the Court grants permission under CPR 5.4C(6), no non-party many obtain a copy of any unredacted statement of case.
iv. Any person wishing to vary or discharge this Order must make an application, served on each party.
(2) Interested Party: NHS England, named in these proceedings as an Interested Party, shall be removed forthwith as a party to these proceedings.
(3) Permission: Permission to apply for judicial review is refused.
(4) Costs: The Claimants must pay the Defendant’s costs of preparing the Acknowledgement of Service and Summary Grounds of Defence, summarily assessed in the sum of £7,026.60.
(5) Further provision as to costs:
(a) Where the Claimants do not make a valid request for reconsideration of the decision to refuse permission to apply for judicial review (see notes below):
(i) Within 14 days of the date of this Order, the Claimants may file and serve a notice of objection (maximum 3 pages) showing why the order in paragraph 4 should not be made. The notice should include any objections to the principle that costs should be paid and/or as to the amount assessed.
(ii) If the Claimants do not file and serve a notice of objection within that period, paragraph 2 is a final order and the Claimants must pay the sum specified within 14 days of the date of this Order (in accordance with CPR 44.7(1)(a)).
(iii) If the Claimants file and serve a notice of objection in accordance with (i) above:
- the other party may, within 14 days after the date on which the notice is
served, file and serve submissions in response (maximum 3 pages); - if the other party files and serves on the Claimants submissions in response, the Claimants may, within 7 days after the date on which the other party’s submissions in response are served, file and serve reply submissions (maximum 3 pages);
- the Court will determine what costs order to make on the papers;
- any costs ordered must be paid within 14 days of the date of the Court’s order (in accordance with CPR 44.7(1)(a)), unless the Court specifies another date.
(b) Where the Claimants make a valid request for reconsideration (see notes below):
(i) Paragraph 4 does not become final as respects the costs payable to any party unless, insofar as it relates to that party:
- the Claimants withdraw the application for permission; or
- permission to apply for judicial review is refused on all grounds after a hearing.
(ii) If the Claimants wish to contend that the order in paragraph 4 should not be made even if permission is refused on all grounds, the Claimants must within 14 days after the date of this Order file and serve (together with the request for reconsideration) a notice of objection (maximum 3 pages). The notice should include any objections to the principle that costs should be paid and/or as to the amount assessed.
(iii) If the Claimants file and serve a notice of objection in accordance with (ii) above:
- the other party may, within 7 days after the date on which the notice is served, file and serve submissions in response (maximum 3 pages);
- if the other party files and serves on the Claimants submissions in response, the Claimants may, within 7 days after the date on which those submissions are served, file and serve reply submissions (maximum 3 pages);
- the Court will determine what costs order to make at or after the permission hearing;
- any costs ordered must be paid within 14 days of the date of the Court’s order (in accordance with CPR 44.7(1)(a)), unless the Court specifies another date.
(6) Renewal directions: Where the Claimants make a valid request for reconsideration (see notes below), the following directions apply:
(a) The permission hearing is to be listed with a time estimate of 2 hours, including submissions by the parties and an oral judgment by the judge. If the Claimants consider that more time should be allowed, the time estimate must be included with the request for reconsideration of permission.
(b) Within 21 days of the service of this Order, the Claimants must file and serve an electronic copy of the Permission Hearing Bundle, prepared in accordance with the guidance on the Administrative Court website and containing the following documents:
(i) the Claim Form, Statement of Facts and Grounds and any evidence or other documents filed with the Claim Form;
(ii) any Acknowledgment of Service, Summary Grounds of Defence and any accompanying documents served by any Defendant and/or Interested Party;
(iii) any Reply or other document served by any party to the proceedings at the paper permission stage;
(iv) this Order;
(v) the renewed application for permission to apply for judicial review (on Form 86B);
(vi) any other document the Court would be likely to consider material to its decision on permission to apply for judicial review.
(c) If the Claimants fail to comply with sub-paragraph (b), permission will be determined on the basis of the renewal notice and the documents before the Court at the paper stage, unless at the hearing the Court otherwise directs.
(d) At least 7 days before the date listed for the hearing, the Claimants must file and serve:
(i) a skeleton argument, maximum 10 pages;
(ii) an electronic bundle containing any authorities which the Court needs to read at the hearing (the Authorities Bundle: see para. 22.1.2 of the Administrative Court Judicial Review Guide); and
(iii) if requested by the Court, a hard copy version of the Permission Hearing Bundle and Authorities Bundles.
(e) At least 7 days before the date listed for the hearing, any party other than the Claimants intending to participate in the hearing must file and serve any skeleton argument, maximum 10 pages.
(f) If a party fails to comply with sub-paragraph (b), (d) and/or (e), the Court may have regard to the failure when considering any question about costs at the hearing.
REASONS
(1) This claim concerns the time that has been taken by the Secretary of State to make a decision as whether to ban the prescribing to children by private providers of masculine and feminising hormones (“cross sex hormones”) for the treatment of gender incongruence. It is alleged that there has been an unreasonable, and therefore unlawful, delay in making that decision.
(2) The claim follows the April 2024 publication of Dr (now Baroness) Hillary Cass’s review into the treatment of children with gender incongruence. The then Secretary of State introduced an emergency temporary ban on the private prescription of “puberty blockers” to children in May 2024, which was made permanent in December 2024. The Cass Report recommended that the Secretary of State identify statutory solutions to prevent the inappropriate private prescribing of both puberty blockers and cross sex hormones.
(3) On 21 May 2025, the Divisional Court refused an application for permission for judicial review challenging the decision of the Secretary of State not to prohibit the supply to children of cross sex hormones. In the summary grounds of defence, the Secretary of State asserted that no positive decision had yet been made about cross sex hormones, but was assessing what approach to take. It was explained that a working group had recently been established to gather data and expert evidence in respect of the use of cross sex hormones and would give advice to the Secretary of Sate within eight weeks from the date of its commission. The Secretary of State contended that the claim for judicial review was premature and academic and no reviewable decision had been made.
(4) The Divisional Court held that the Secretary of State’s actions were not arguably irrational. The Divisional Court outlined the difference between puberty blockers and cross sex hormones: that the situation with the former made it relatively straightforward to formulate policy and draft legislation to ban puberty blockers, but the Secretary of State was of the view that the situation with the latter was different. Cross sex hormones are used in much greater volumes for a wide range of conditions, and that presented operational difficulties if they were to be subjected to a statutory ban.
(5) The Divisional Court rejected a contention that there had been unlawful delay. The Divisional Court observed that whilst it was permissible for the Secretary of State to delay in addressing cross sex hormones at that point in time, this may not be a position “which endures indefinitely”. The Divisional Court reflected that the Secretary of State would no doubt treat the issues with “the urgency and the intensity of review which they require”.
(6) No decision has yet been made by the Secretary of State, and the Claimants contend that this delay is unreasonable. It is contended that the Secretary of State cannot avoid scrutiny by simply maintaining indefinitely that the matter remains under consideration. Reliance is placed on three key features: (i) the consequences of the delay which are said to be profound, given the risks associated with cross sex hormones; (ii) the nature of the group exposed to the risk: highly vulnerable children; and (iii) the risk posed by ideologically driven private providers.
(7) I do not consider that it is arguable that the delay is unreasonable. The decision that the Secretary of State is considering is complex and requires proper evaluation of the evidence and risks, the potential unintended consequences of legislating to restrict their access, and the range of possible measures that are available. The situation for cross sex hormones is different from puberty blockers given the different uses for which they may be sought. As explained in the Summary Grounds (and not substantially contradicted by the Claimants)
“For teenagers, female hormones are used to treat menstrual and gynaecological issues as well as for gender affirmation, some of this being “off label” use. In adults, both female and male hormones are used for a range of issues including relating to menopause and gynaecological issues as well as with cancer patients. Around 400,000 prescriptions for contraceptives are issued to under 18s in primary care settings each year, which includes feminising hormones such as oestrogen, as well as progesterone containing products. Much larger numbers of prescriptions are issued to teenagers and adults (e.g. over 2 million 16 patients regularly take hormones for hormone replacement therapy) compared to relatively small numbers using CSHs for gender dysphoria.”
(8) It is clear from the Summary Grounds that the Secretary of State (and officials acting on his behalf) have not sat on their hands since the decision of the Divisional Court in May 2025. Rather, there has been considerable work on development of the appropriate policy. This has included work to understand how to proceed with options, particularly in relation to ending recognition of EEA/Swiss prescriptions. Evidence about this was called for and the responses have required proper analysis. There have also been regular meetings with a wide variety of stakeholders (including regulators, Devolved Administrations, the affected professions) to discuss practical workability of possible restrictions, risks to patients and how they might be mitigated. There has been engagement with the Northern Ireland Executive, given the complexities of prescriptions from the Republic of Ireland across the border.
(9) It has been explained that advice was submitted to Ministers on 31 March 2026. Further consultation with Baroness Cass has taken place. Further advice as to whether to end recognition of EEA/Swiss prescriptions was submitted. A new Secretary of State (who took office on 14 May 2026) will need to consider all of the advice and available evidence so as to make a decision.
(10) In these circumstances, whilst there is no doubt that the decision has taken longer than the Claimants would have wished, and maybe longer than the Divisional Court contemplated when they made their decision in May 2015, it is not arguable that the delay is irrational in a Wednesbury sense. The decision making itself concerns a matter where there the Secretary of State has a broad discretionary area of judgment; the same must apply to the process required for the Secretary of State to make the relevant decision.
(11) I am supported in this analysis by the fact that the Claimants have not identified any properly analogous case in which a Minister of the Crown has been held to have acted unlawfully by delaying their decision-making. This is not a challenge to the decision making process affecting one individual or even a small group of individuals. Rather, it is a challenge to a decision making process which involves consideration of complex policy issues where the consequences affect very large numbers of individuals with potentially competing interests given that cross sex hormones are used for a variety of medical conditions.
(12) Nothing in this decision should be taken to suggest, however, that the Secretary of State can keep the decision under consideration indefinitely. It does not appear to me, however, that it is the intention of the Secretary of State, or that the time has been reached when it can be said that “right or justice” is being delayed or denied within the spirit of Magna Carta.
(13) I do grant anonymity in this case for the First Claimant and the Chair of the Second Claimant, as well as to withhold addresses. The anonymity order for the First Claimant should protect the identity of their daughter, who is vulnerable. There are also concerns about abuse being directed at the First Claimant and/or the Chair of the Second Claimant if their identities and addresses are publicly available. These concerns can be addressed by suitably tailored orders. The press, or others affected, are at liberty to apply to set aside or vary these orders.
Signed: Mr Justice Sheldon
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17 July 2026