Failing children’s gender service to be replaced by local hubs

The NHS’ only gender identity clinic for children is neither “safe nor viable” and is set to be replaced by regional hubs.

A damning report into gender identity services, run by The Tavistock and Portman Foundation Trust, has found the model is putting children at “considerable risk.”

An interim report by Dr Hilary Cass, said children and young people are being subjected to “lengthy” waits for accessing gender dysphoria services and not receiving support during their waits.

The report said a “fundamentally different” service model is needed which can provide timely and appropriate care for children and recommended the NHS launch local specialist centres.

In response NHS England said the contract with the Tavistock will be brought to a close and two services established by specialist children’s hospitals in London and the north west. It will aim to establish these by Spring 2023.

The current service, run by The Tavistock and Portman Hospital, has previously been accused of rushing children into hormonal treatment.

According to board papers published by the hospital this week there were more than 5,000 children waiting following a referral to its gender identity dysphoria service at the end of March 2022. The service is only just seeing patients who were referred in 2018.

The waiting list for patients referred to its gender identity clinic was more than 10,000 at the end of 2021-22 and the service was seeing patients originally referred in 2017.

The trust document also shows it had 22 patient safety incidents in the last quarter of 2021-22, which included an attempted suicide.

Children with gender-related distress, Dr Cass said, have been disadvantaged because local services are not equipped to see them.

She said: “It is essential that they can access the same level of psychological and social support as any other child or young person in distress, from their first encounter with the NHS and at every level within the service.”

Dr Cass’ interim report highlighted challenges within The Tavistock’s service which included staff concerns about care raised in 2018.

Her full report is due to be published next year but has so far warned the long waiting lists for gender questioning children and young people are “unacceptable.”

The review said it was not able to yet provide recommendations on the use of puberty blockers and feminising or masculinising hormones due to gaps in the evidence.

In a letter to children impacted by the changes Dr Cass said: “I have heard that young service users are particularly worried that I will suggest that services should be reduced or stopped. I want to assure you that this is absolutely not the case – the reverse is true. I think that more services are needed for you, closer to where you live…

“I am advising that more services are made available to support you. But I must be honest; this is not something that can happen overnight, and I can’t come up with a solution that will fix the problems immediately. However, we do need to start now.”

A report from safety watchdog the Healthcare Safety Investigation Branch in April warned CAMHS services have been forced to “hold the risk” while caring for children who are waiting to access specialist gender dysphoria services.

It added: “There is a lack of capacity and capability to ensure proactive risk assessment of the health of patients waiting on the GIDS waiting list.”

The review was prompted by the death of an 18 year old transgender man who had been referred to GIDs at 16 years old.

At 17 years old he was told he would not be seen for 22 months but took his own life before his 19th birthday.

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