Why the UK’s only gender identity clinic for children is closing and how the NHS plans to replace itEXPLAINED
The NHS said it is taking ‘immediate steps’ to establish two services led by specialist children’s hospitals instead
The Gender Identity Development Service (GIDS) clinic at Tavistock
Tavistock and Portman NHS foundation trust, the UK’s only dedicated gender identity clinic for children and young people, is to close after an independent review criticised its services
(Photo: Peter Nicholls/Reuters)
By Joe Duggan
July 28, 2022
The NHS is closing Britain’s only gender identity clinic for children and young people after a critical report found that having only one provider was “not a safe or viable long-term option”.
Instead, the health service will replace the Gender Identity Development Service (GIDS) at the Tavistock & Portman NHS Foundation Trust in London with a regional network.
The NHS is aiming to close the clinic by next Spring following an interim review led by Dr Hilary Cass. It intends to build a “more resilient service” by expanding provision through the network.
The NHS said it is taking “immediate steps” to establish two services led by specialist children’s hospitals in London and the North West, with a view to build a national regional network of around eight services “given the urgent requirement to stabilise current service provision for patients”.
It said the network will take a more “holistic” approach to treatment and examine other mental health or medical issues patients may present alongside any gender work.
Why is the clinic closing?
The Tavistock GIDS clinic opened in 1989 to help children under 18 who were struggling with their gender identity.
Thursday’s announcement of its closure comes after recommendations from Dr Cass, who is leading an independent review into gender identity services for children and young people.
Earlier this year, Dr Cass found that the number of children seeking NHS help “is now outstripping the capacity of the single national specialist service” and there was a need to move away from the model of a sole provider.
In her interim report, released in March, she wrote: “It has become increasingly clear that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand.”
What problems have previously been identified?
Dr Cass’s interim report found the rise in GIDS referrals at the trust had left staff overwhelmed and under “under pressure to adopt an unquestioning affirmative approach”.
This had left young people “at considerable risk” of distress and deteriorating mental health, with the service struggling with long waiting lists.
In a highly critical report, the Care Quality Commission (CQC) told GIDS that their services and waiting times “must improve significantly”.
The CQC demanded a report of the number of patients on the waiting list, including monthly figures of new referrals awaiting an assessment.
A High Court case was brought against the Tavistock challenging its use of puberty blockers, a treatment offered to children and young people questioning their gender.
The case was led by Keira Bell, who was referred to the service at 16 and prescribed hormone blockers to pause her puberty. She underwent further treatment as an adult before deciding she no longer identified as transgender.
By Joe Duggan
July 28, 2022
The NHS is closing Britain’s only gender identity clinic for children and young people after a critical report found that having only one provider was “not a safe or viable long-term option”.
Instead, the health service will replace the Gender Identity Development Service (GIDS) at the Tavistock & Portman NHS Foundation Trust in London with a regional network.
The NHS is aiming to close the clinic by next Spring following an interim review led by Dr Hilary Cass. It intends to build a “more resilient service” by expanding provision through the network.
The NHS said it is taking “immediate steps” to establish two services led by specialist children’s hospitals in London and the North West, with a view to build a national regional network of around eight services “given the urgent requirement to stabilise current service provision for patients”.
It said the network will take a more “holistic” approach to treatment and examine other mental health or medical issues patients may present alongside any gender work.
Why is the clinic closing?
The Tavistock GIDS clinic opened in 1989 to help children under 18 who were struggling with their gender identity.
Thursday’s announcement of its closure comes after recommendations from Dr Cass, who is leading an independent review into gender identity services for children and young people.
Earlier this year, Dr Cass found that the number of children seeking NHS help “is now outstripping the capacity of the single national specialist service” and there was a need to move away from the model of a sole provider.
In her interim report, released in March, she wrote: “It has become increasingly clear that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand.”
What problems have previously been identified?
Dr Cass’s interim report found the rise in GIDS referrals at the trust had left staff overwhelmed and under “under pressure to adopt an unquestioning affirmative approach”.
This had left young people “at considerable risk” of distress and deteriorating mental health, with the service struggling with long waiting lists.
In a highly critical report, the Care Quality Commission (CQC) told GIDS that their services and waiting times “must improve significantly”.
The CQC demanded a report of the number of patients on the waiting list, including monthly figures of new referrals awaiting an assessment.
A High Court case was brought against the Tavistock challenging its use of puberty blockers, a treatment offered to children and young people questioning their gender.
The case was led by Keira Bell, who was referred to the service at 16 and prescribed hormone blockers to pause her puberty. She underwent further treatment as an adult before deciding she no longer identified as transgender.
How will people get treatment after GIDS closes?
The NHS said it intends to build a “more resilient service” by expanding provision into a regional network, and is taking “immediate steps” to establish two services led by specialist children’s hospitals in London and the North West.
The health service hopes to have the services fully up and running by spring, 2023.
It described the two new services as the “first step” in a national regional network “given the urgent requirement to stabilise current service provision for patients”.
Altnough the final number in the network has not yet been confirmed, up to eight services could ultimately be put in place.
Where will the services be based?
One London-based service will be led by Great Ormond Street Hospital and Evelina London Children’s Hospital, with South London and Maudsley NHS Foundation Trust providing specialist mental health support.
A second service in the North West will be led by Alder Hey Children’s NHS Foundation Trust and the Royal Manchester Children’s Hospital, with both trusts providing specialist mental health services.
These two services will take over clinical responsibility for all GIDS patients, including those on the waiting list.
How much demand has there been for GIDS?
Over the past decade there has been a sharp increase in referrals to the clinic, with more than 5,000 in 2021/22, compared with less than 250 in 2011-12.
But as demand surged the waiting times for assessments lengthened, and the Cass review was commissioned in September 2020 to ensure that children and young people are able to access the best possible support from the NHS.
The NHS also highlighted a “lack of clinical consensus and polarised opinion” around the best model of care for children questioning their gender, as well as a “lack of evidence to support families in making informed decisions about interventions that may have life-long consequences”.
The NHS said the clinic in London is set to be replaced by regional centres which it hopes to open fully in the spring (Photo: Reuters/Peter Nicholls)
There had been a “dramatic change” in who was being referred, with more children registered female at birth, neurodiverse children and children with mental health needs.
The review’s interim report warned that many of those being referred have complex needs but that, once they are identified as having gender-related distress, other healthcare issues “can sometimes be overlooked”.
Its final report is expected in 2023.
What has the reaction been?
A Stonewall spokesperson said the organisation was pleased that “the NHS has acted decisively to address the unacceptable waiting times faced by trans young people in accessing specialist gender identity-related healthcare, by expanding the support it provide” following the interim Cass Review.
“The creation of new specialist regional centres in London and Manchester next year, with more to follow, will go some way to addressing the strain experienced by having just a single, centralised service,” the spokesperson added.
Ms Bell said she was “over the moon” at the announcement the clinic would close.
A GIDS spokesperson said the service appreciated how difficult long waits are for young people seeking treatment, and the new measures represent “significant progress in expanding capacity” and that the trust supports the need for a more sustainable model amid the rise in referrals.
Following recommendations by Dr Cass, the NHS also said it will carry out clinical research to track under-16s who are on puberty blockers into adulthood in order to counter “polarised opinion and conjecture” with evidence.”
The NHS said it will ensure greater transparency around “the uncertain clinical benefits and longer-term health impacts surrounding their use”.
While the research is ongoing patients will continue to be able to access treatment, it added.
There had been a “dramatic change” in who was being referred, with more children registered female at birth, neurodiverse children and children with mental health needs.
The review’s interim report warned that many of those being referred have complex needs but that, once they are identified as having gender-related distress, other healthcare issues “can sometimes be overlooked”.
Its final report is expected in 2023.
What has the reaction been?
A Stonewall spokesperson said the organisation was pleased that “the NHS has acted decisively to address the unacceptable waiting times faced by trans young people in accessing specialist gender identity-related healthcare, by expanding the support it provide” following the interim Cass Review.
“The creation of new specialist regional centres in London and Manchester next year, with more to follow, will go some way to addressing the strain experienced by having just a single, centralised service,” the spokesperson added.
Ms Bell said she was “over the moon” at the announcement the clinic would close.
A GIDS spokesperson said the service appreciated how difficult long waits are for young people seeking treatment, and the new measures represent “significant progress in expanding capacity” and that the trust supports the need for a more sustainable model amid the rise in referrals.
Following recommendations by Dr Cass, the NHS also said it will carry out clinical research to track under-16s who are on puberty blockers into adulthood in order to counter “polarised opinion and conjecture” with evidence.”
The NHS said it will ensure greater transparency around “the uncertain clinical benefits and longer-term health impacts surrounding their use”.
While the research is ongoing patients will continue to be able to access treatment, it added.
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