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Category: Tavistock Centre

  • Newly proposed healthcare guidance rings alarm bells for trans youth

    Regional services are due to replace the NHS Gender Identity Development Service (GIDS) which used to serve trans youth in the UK. England has now released its interim specification for these services. However, the specification has set alarm bells ringing for trans rights groups. They claim that the proposed changes would set back the standard of healthcare for trans youth, rather than advancing it.

    The Cass Review

    The specification was released in reaction to the findings of the Cass Review. The Cass Review was an independent investigation conducted by Dr Hilary Cass. Commissioned by NHS England and NHS Improvement, the review sought to:

    make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence.

    Previously, care for trans youth was centralised in the Tavistock Centre. The Tavistock formed a bottleneck because it simply could not deal with the volume of patients required. The interim findings of the Cass Review stressed that the old model simply wasn’t working. It stated that:

    The rapid increase in the number of children requiring support and the complex case-mix means that the current clinical model, with a single national provider, is not sustainable in the longer term.

    It also stressed that trans youth deserve the same level of healthcare as any other individual in the UK:

    Children and young people with gender incongruence or dysphoria must receive the same standards of clinical care, assessment and treatment as every other child or young person accessing health services.

    However, experts have criticised the NHS response to these assertions for raising further barriers to healthcare for trans youth.

    Interim specification

    The actions and measures set out in the interim specification have received wide-ranging criticism from professional bodies and trans advocacy organisations. The trans healthcare organisations which have voiced their concerns include the World Professional Association for Transgender Health (WPATH); its counterparts in Asia (ASIAPATH), Europe (EPATH), and America (USPATH); the Professional Association for Transgender Health Aotearoa (PATHA);  and the Australian Professional Association for Transgender Health.  Evidenced critiques have also been set out by specialist Dr Natacha Kennedy and trans youth advocate Cal Horton.

    Grassroots trans charity Gendered Intelligence has released a statement in reaction to the interim specification. It said:

    the new service specification seems likely to repeat – even exacerbate – the problems already faced by GIDS. Changes seem intended to reduce the number of referrals and the scope of available treatments, rather than improve access.

    Even more so than many other NHS services, GIDS was already massively overstretched, with wait times of several years. The response to this, however, cannot be to create further barriers in order to artificially reduce the number of people receiving treatment.

    Alarm bells

    Gendered Intelligence also highlighted an important fact. The specification suggests that children should be reported to social services if they seek trans healthcare through pathways other than the NHS. Expressing concern over this suggestion, the charity stated:

    Young people who are already receiving puberty delaying treatments or hormone therapies from private sources may find themselves threatened with safeguarding alerts and refused transfer into NHS services. This makes it more likely that people will avoid talking to their doctors about self-medication, and could force young people into a terrible choice between either detransitioning or being denied NHS care entirely.

    It’s also deeply troubling that the interim specification seems to suggest that doctors and healthcare providers should have a say in a child’s social transition. Social transition consists of an individual changing their presentation, such as clothing and hairstyle, and often their name and pronouns. These are aspects of a child’s daily life, and they should surely be beyond a doctor’s influence. Gendered Intelligence said of social transition:

    Not only is it both harmless and reversible, it actually benefits young people to be able to safely explore their identities in this way.

    We need to push back

    The NHS is currently running a public consultation on the changes proposed in the interim specification. It is open until 4 December. If you are able, please respond to condemn this setback for trans youth care. Dr Ruth Pearce, former ‘patient public voice’ of the NHS England Gender Programme Board, highlighted that this struggle is part of a wider fight for self-determination for marginalised youth. Pearce said that the proposed changes:

    will impact other young people more widely – especially girls and LGBTIQ+ youth – by undermining principles of autonomy and respect.

    Trans youth deserve healthcare. They deserve to receive treatment in a timely fashion, from professionals who have their best interests at heart. The interim specification fails to provide these assurances on multiple levels – and so fails those same children it purports to help.

    You can read the specification itself here.

    A detailed breakdown of its contents and guidance on how to respond can be found here. The deadline is 4 December.

    Featured image via Wikimedia Commons, resized to 770*403

    By Alex/Rose Cocker

  • Overturned ruling on puberty-blocking drugs is good news for trans kids

    An NHS trust has won a Court of Appeal bid to overturn a landmark ruling over the use of puberty-blocking drugs for children with gender dysphoria.

    Victory for trans children

    Last year, the High Court ruled it was “highly unlikely” that a child aged 13 or under would be able to consent to the hormone-blocking treatment. And it said that it was “very doubtful” a child of 14 or 15 would understand the long-term consequences. The Tavistock and Portman NHS Foundation Trust brought an appeal against the ruling in June. The trust runs the UK’s only gender identity development service for children.

    In a judgment on 17 September, the Court of Appeal said that it was “inappropriate” for the High Court to have given the guidance. And the court found that it is up to doctors to “exercise their judgment” about whether their patients can properly consent.

    In their ruling, the lord chief justice Burnett, sitting with Geoffrey Vos and lady justice King, said:

    The court was not in a position to generalise about the capability of persons of different ages to understand what is necessary for them to be competent to consent to the administration of puberty blockers.

    Burnett added:

    It placed patients, parents and clinicians in a very difficult position.

    Denied treatment

    The Court of Appeal found that this recommendation would have practically denied treatment “in many circumstances” if patients didn’t have the resources to go to court. However, Burnett said there may be occasions where an application to the court may be appropriate, for example, if there’s a dispute between doctors or parents.

    The three senior judges also found that the High Court’s guidance would require doctors “to suspend, or at least temper, their clinical judgment and defer to what amounts to the clinical judgment of the court”. Burnett concluded:

    Clinicians will inevitably take great care before recommending treatment to a child and be astute to ensure that the consent obtained from both child and parents is properly informed by the advantages and disadvantages of the proposed course of treatment

    The judges also said that treating children for gender dysphoria is “controversial” and subject to “intense professional and public debate”. Burnett added:

    Such debate, when it spills into legal proceedings, is apt to obscure the role of the courts in deciding discrete legal issues

    Potential appeal

    The original case was brought by Keira Bell. Bell is a 24-year-old woman who began taking puberty blockers when she was 16, before later “detransitioning”. She’s also the mother of a teenager who is on the waiting list for treatment.

    Following the ruling, Bell said she was “surprised and disappointed” in the decision. But she said she had no regrets in bringing the case, adding:

    It has shone a light into the dark corners of a medical scandal that is harming children and harmed me

    Adding that she believed the medical service had become “politicised”, Bell said she will be seeking permission to appeal to the Supreme Court.

    Clinical judgement

    During the two-day appeal earlier in 2021, the Tavistock’s lawyers argued that the ruling was “inconsistent” with the concept that young people may be able to consent to their own medical treatment, known as Gillick after a case about access to the contraceptive pill for under 16s in the 1980s.

    The Court of Appeal highlighted the similarities between the cases, adding:

    Nothing about the nature or implications of the treatment with puberty blockers allows for a real distinction to be made between the consideration of contraception in Gillick and of puberty blockers in this case bearing in mind that, when Gillick was decided 35 years ago, the issues it raised in respect of contraception for the under-16s were highly controversial in a way that is now hard to imagine.

    Tavistock welcomed the judgement. A trust spokesperson said:

    The judgment upholds established legal principles which respect the ability of our clinicians to engage actively and thoughtfully with our patients in decisions about their care and futures.

    It affirms that it is for doctors, not judges, to decide on the capacity of under-16s to consent to medical treatment.

    We recognise the work we do is complex and, working with our partners, we are committed to continue to improve the quality of care and decision making for our patients and to strengthen the evidence base in this developing area of care.

    By The Canary

    This post was originally published on The Canary.