NHS England Reviews Gender Identity Services for Children and Young People

Becky McCall

February 04, 2020

Gender identity development services (GIDS) in England will be the subject of an independent review of services including the use of puberty blockers and cross-sex hormones in children and young people, announced NHS England a few days ago.

The review comes in the midst of mounting concerns in recent months from ex-staff and patients from England's only NHS GIDS for young people (the Tavistock and Portman NHS Foundation Trust), that services need reform, with claims that young people are being fast-tracked into medical treatment to transition without adequate counselling.

Moreover, increasing numbers of transgender individuals are publicly declaring their wishes to detransition, often years after receiving treatment. In recognition of this dissatisfaction with transgender care as it currently stands, the Detransitioning Advocacy Network, a platform on Twitter where views can be aired and shared around this sensitive topic, launched in November 2019.

Independent Expert Group

NHS England explained that an independent expert group is being established to make recommendations on the evidence around the use of puberty suppressants and cross-sex hormones, and to determine whether any changes are required to existing clinical policies that underpin the use of these on the NHS.

The National Institute for Health and Care Excellence (NICE) will also undertake a thorough review of the latest clinical evidence to help inform the independent working group’s review.

The current review follows on from a service specification for nationally commissioned GIDS for children and young people that was established in 2016. At the time, NHS England committed to conducting a review of this specification and associated policies in 2020.

Dr Hilary Cass, consultant paediatrician at Guy’s and St Thomas’ NHS Foundation Trust, London, and previously a president of the Royal College of Paediatrics and Child Health, has been appointed to chair the independent group. In a press release from NHS England, she said: "This is a fast-developing area of medicine with emerging evidence and high public interest. I look forward to chairing this independent group, bringing together medical and non-medical experts with a range of perspectives, to make evidence-based recommendations about the future use of these drugs."

Names of the other members have not yet been disclosed, but patients, families, experts and other interested parties will be invited to comment on the draft specification. To inform the review of the wider service specification, NHS England has asked NICE to develop guidance that will help identify when to refer children and young people to specialist services.

High Court Yet to Decide on Judicial Review

Psychoanalyst Susan Evans, who is also an ex-staff member of the Tavistock Centre, resigned from the service 16 years ago because she felt 'deeply concerned' about how young people failed to routinely receive sufficient counselling prior to referral for medical treatment. Now Evans, alongside the mother of a 15-year-old girl with gender dysphoria, and Keira Bell, 23, who as an adolescent received puberty blockers and cross-sex hormones at the Tavistock, are seeking a Judicial Review of the Tavistock GIDS practices. A decision as to whether this Judicial Review will go ahead should be made in the next few weeks.

Evans seeks a ruling from the High Court that the current practice for informed consent for hormone treatments for children aged under 18 years be deemed 'unlawful'. Through a crowd-funded legal case she aims to prove that this kind of experimental treatment is unsuitable in under-18s due to the adult nature of the potential side effects. Medscape UK reported on the case in January. In an interview at the time, Evans explained her grievances. "I am concerned that the burden of hormonal treatment for children is very great. In particular this first step on the medical pathway."

Medscape News UK spoke to Paul Conrathe of Sinclairs Law, who is representing the case. He explained the basis of the case which challenges the legal justification upon which GIDS offers treatment to children. “We believe that there are insufficient legal safeguards to protect children from undergoing experimental medical treatment which will have significant life-long consequences.”

"The children are making life-altering decisions in an evidential vacuum at a significantly vulnerable time in their lives. This requires legal clarity on what constitutes informed consent as well as a framework of legal protection," he added.

Regarding the NHS England Independent review, he pointed out that, "The NHS independent inquiry will address clinical practice that takes place within the legal context. It cannot take the place of the courts in establishing or clarifying legal duties, obligations and safeguards."

NHS England Programme Board for Gender Dysphoria Services

The NHS England website explains that NHS England has established a Programme Board for Gender Dysphoria Services, and a Clinical Reference Group (CRG) will give independent expert advice on the various aspects of the Board’s work.

With respect to GIDS overall - children and adults – amongst various proposed initiatives, the NHS website says that in 2019/20 the Programme Board for Gender Dysphoria Services will consider designation of one or two Gender Dysphoria Clinics to function as a National Trans Health Unit to manage a national network of Gender Dysphoria Clinics; establish a pioneering gender dysphoria service in a community or primary care setting in Greater Manchester, as a pilot for evaluation; and establish a new quality framework that requires designated providers to report meaningful clinical indicators, and that includes Patient Reported Outcome and Experience Measures. 


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