NHS Tavistock youth gender clinic to be replaced under sweeping trans healthcare reforms
NHS England is to close its sole dedicated youth gender clinic and open new regional centres in a move to a “holistic and localised approach” to trans youth healthcare.
The Tavistock and Portman NHS Foundation Trust will shut down its Gender Identity Development Service (GIDS) by next spring, NHS England said Thursday (28 July).
It comes after a recommendation by Dr Hilary Cass that gender-affirming care be provided by regional centres “led by experienced providers of tertiary paediatric care to ensure a focus on child health and development, with strong links to mental health services”.
Dr Cass, who is conducting a review of gender-affirming care commissioned by NHS England, noted that the current model is unable to keep up with growing demand, resulting in spiralling wait times.
NHS England said that “given the urgent requirement to stabilise current service provision” it will establish two “Early Adopter services” run by specialist children’s hospitals.
Young trans people who are currently under GIDS service or on the waiting list will be moved to regional centres as the NHS embraces a “holistic and localised approach”.
For now, there will be no immediate change to the care offered by the clinic.
The Early Adopter services will be opened by 2023 with the aim of “achieving a smooth and seamless transfer for all patients, minimising any disruption”, the Tavistock and Portman NHS Foundation Trust said in a statement.
An Early Adopter service in London will be led jointly by Great Ormond Street Hospital and Evelina London Children’s Hospital, with South London and Maudsley NHS Foundation Trust providing specialist [children and young people] mental health support.
Alder Hey Children’s NHS Foundation Trust and the Royal Manchester Children’s Hospital will provide the service for trans youth in the north-west of England.
As part of the reforms, NHS England said it will conduct further research into puberty blockers, drugs that act as a pause button on puberty. The treatment, a raft of research has shown, can be “life-saving” for trans youth.
One study found that gender-affirming healthcare for trans youth was associated with 60 per cent lower odds of depression and 73 per cent lower odds of suicide.
But at Cass’ suggestion, NHS England will work together with the National Institute for Health and Care Research to better research puberty blockers and get a new process for proscribing puberty blockers up and running once the report is finished.
Those receiving hormonal therapies will have to sign up to participate in the research project on the condition of accessing the treatment, however.
The Tavistock and Portman NHS Foundation Trust said it expects the reforms will cut down waiting lists once the doors to the local hubs have opened.
The trust said in a statement: “The Trust supports the need to establish a more sustainable model for the care of this group of patients given the marked growth in referrals. The expertise that resides within the current GIDS service will be critical to the successful formation of these early adopter services and providing continuity in patient care.
“We will work closely with partners and commissioners to ensure a smooth transition to the new model of delivery. Over the last couple of years, our staff in GIDS have worked tirelessly and under intense scrutiny in a difficult climate.
“We are proud of them and thankful for their unrelenting patient focus and extraordinary efforts.”
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The decision came in response to the interim Cass Review, which gave the bold suggestion that trans youth should have more than one service in the entire country.
Dr Hilary Cass OBE, a former president of the Royal College of Paediatrics and Child Health, wrote in a letter to NHS national director John Stewart stressing the “need to move from a single national provider to a regional model”.
She said: “A comprehensive patient and family-centred service and package of care is needed to ensure children and young people who are questioning their gender identity or experiencing gender dysphoria get on the right pathway for them as an individual.”
With waiting lists at the Tavistock stretching several years, Cass called on the NHS to offer help to trans youth “at the earliest feasible point in their journey”. She suggested healthcare providers band together during “intake meetings” to help fastrack care for those deemed “at risk”.
A separate report by the Care Quality Commission in 2020 found there were more than 4,600 young people on the GIDS waiting list, with some waiting more than two years for their first appointment. Inspectors rated Tavistock as “inadequate” as a result.
While anti-trans campaigners have painted puberty-blockers as readily available, not a single trans person under 17 had been given an initial assessment with an endocrinologist, who assess and approves hormone therapies, between December 2020 and September 2021, an investigation by i found.