A Conflict of Interest Too Great to Ignore
By Rachel Cashman, The Fearless Facilitator: advising leaders on culture and governance and living the consequences of failures in NHS Sussex.
When the Cass Review was published, I wrote about the need to hold space for complexity and contention (Holding Space in Complexity and Contention – Fearless Facilitator). Safeguarding, I argued, is not served by collapsing into ideology whether activist fervour or bureaucratic denial but by evidence, integrity, and accountability.
Now, for the first time, I write not only as a professional who has worked for and with the NHS on leadership, governance, strategy and safety, but as someone whose own family is affected by the failures now under investigation in Sussex.
NHS Sussex Integrated Care Board (ICB) has announced an investigation into prescribing practices at WellBN in Brighton and Hove regarding concerns that the Practice may have ‘inappropriately offered puberty‑suppressing, masculinising and feminising hormones to individuals under 18’ including those under 16 without necessary paediatric or mental health oversight’(NHS Sussex Terms of Reference) . At face value, this seems like the responsible next step. But the terms of reference make one thing unavoidably clear: NHS Sussex intends to investigate itself.
That cannot stand.
The clinician at the heart of this investigation has publicly admitted that NHS Sussex knew of, and funded, prescribing practices to 16-year-olds. In this video made only a few weeks ago (Sarah Savage Interviews Dr Sam Hall), he described expanding his patient list from 60 to 2,500 with NHS Sussex’s knowledge and money, describing himself in this video as “the pied piper of trans healthcare”.
These admissions confirm precisely what families like mine and others within and affected by these issues in the health and care system in Sussex have raised, in legal letters as far back as 2023, concerns which were denied at the time. In fact, the Chief Executive of the NHS Sussex ICB, who remains in post and will have authority over the new investigation, suggested my family take the NHS to court rather than meet with us. A comment for which his superiors nationally at NHS England apologised when they met with us in December that year. Furthermore, in February 2024 NHS England confirmed to me in writing that our concerns had been raised directly with the then National Medical Director. It is staggering that here we are in August 2025, and inquiries are only just beginning.
If the commissioner funded, authorised, and oversaw the practice, it cannot credibly investigate its own complicity. The outcome would be discredited before the ink is dry.
Patterns of Leadership and Culture
This is not an isolated failure. NHS Sussex appointed Dr Dinesh Sinha (former Medical Director of the Tavistock and Portman NHS Trust) as its Chief Medical Officer after he was criticised in the Appleby v Tavistock judgment (Appleby versus Tavistock and Portman NHS Trust), a case in which a safeguarding lead was vindicated after being undermined and obstructed when raising concerns about the very same issues that have come to light in NHS Sussex. The judgement recorded Dr Sinha’s “unsympathetic, almost hostile” behaviour and the Tribunal’s surprise at his evidence.
Despite this, he was elevated to a position of immense responsibility. This appointment reveals something about the culture of governance at NHS Sussex: a tolerance for poor safeguarding judgement, even when it has been publicly exposed.
And this culture of denial has not been confined to NHS Sussex. In a full council meeting in July 2023, the leader of Brighton and Hove City Council described parents’ safeguarding concerns as “baseless smears.” They were not. As she well knew having already been in receipt of legal correspondence from affected families at the time of this retort (Parents seek apology from council leader for calling their concerns ‘baseless smears’ – Brighton and Hove News). They were evidenced, legitimate, and as current events make clear tragically well-founded.
Public institutions are bound by the Nolan principles of integrity, accountability, and openness. When children’s safety is at stake, we should expect better: safeguarding first, and scrutiny not smears, as the standard for taxpayer-funded services.
A Timeline of Warnings, Ignored
The current investigation is not happening because NHS Sussex chose to act. It is happening because a case has been before the High Court, brought by families raising the alarm about prescribing practices in Sussex. A case supported by evidence that I and others have gathered over months (Clinic ‘defying Cass review to prescribe sex change drugs to vulnerable teens’)
Since 2022, we have been documenting the pipeline from classroom to clinic in Brighton and working with families to raise safeguarding concerns. In 2024, I spoke publicly about these issues at the CAN-SG conference (Rachel Cashman: The Fast Track from the Classroom to the Clinic). The reaction to this event which involved police escorts, protests, and smoke bombs outside the venue showed just how contentious this terrain has become. Yet even in that climate, my focus remained what it is today: safeguarding children, free from ideology or intimidation.
Today, for the first time, I also speak as someone directly affected.
The Children at the Centre
This debate is too often dragged into the ‘culture wars’. Activists protest outside buildings, language hardens, and slogans and mantra drown out what matters most: children’s safety.
This is not about ideology. It is about safeguarding. The Cass Review (The Cass Review) laid out, in painstaking evidence, the risks when services grow without proper oversight, when governance is weak, and when complexity is brushed aside in the rush to act.
Families like mine live with the consequences of that failure. The trauma is not theoretical. It is personal.
Independence Is Non-Negotiable
If this investigation is to have credibility, if public trust is to be restored, and if children are to be truly safeguarded, then independence is not optional. It is essential.
If I were back in NHS England HQ now, I would be asking, and searching, for the stuff that has not yet been declared by those in Sussex, any other complaints, risks and correspondence from patients, staff, and parents between 2021 when the WellBN established this service and today as this investigation begins; a full amnesty of all information, claims and concerns.
NHS Sussex is implicated. It cannot investigate itself.
Affected families need to know that the truth will not be buried in process and protectionism. As a professional, I know the only way to rebuild trust is through transparency, accountability, curiosity, discernment, and systematic review of all the evidence.
It is the safety of a child in my family on the line, yet my words here are not driven by anger or activism but by evidence, accountability and safeguarding. If I can hold that balance, surely the system entrusted with protecting children can do the same.