The NHS is shutting down its gender identity clinic for children after a review found that it failed vulnerable under-18s.
The gender identity service at Tavistock & Portman NHS Foundation Trust has been ordered to close by next spring.
It will be replaced by regional centres at existing children’s hospitals offering more “holistic care” with “strong links to mental health services”.
Tavistock’s Gender Identity Development Service (GIDS) clinic has been accused of rushing children into life-altering treatment on puberty blockers.
The paediatrician Dr Hilary Cass, who is leading a review of the service, issued a series of recommendations today for a radical overhaul of how the NHS treats young people who are questioning their gender identity.
In a letter to NHS England, she said there were “critically important unanswered questions” in relation to treatment with puberty blockers.
Cass expressed significant concerns about the hormone drugs, which Tavistock has been prescribing to children as young as ten. She noted that brain development in young children may be “temporarily or permanently disrupted by puberty blockers”. She found that the GIDS clinic was “not a safe or viable long-term option” and that other mental health issues were “overshadowed” when gender was raised by children referred to the clinic. Cass, former president of the Royal College of Paediatrics and Child Health, said the existing model of a sole provider for gender services should be scrapped as it failed to meet the holistic needs of distressed and vulnerable teenagers. She said the GIDS clinic should be replaced by regional centres with an “appropriate multi-professional workforce to enable them to provide an integrated model of care that manages the holistic needs of this population”. Amid concerns that the clinic fails to take into account wider health problems before putting children on puberty blockers, Cass added: “Staff should maintain a broad clinical perspective in order to embed the care of children and young people with gender uncertainty within a broader child and adolescent health context.” NHS England, which commissioned Cass to review the service in September 2020, says it will implement her recommendations in full and decommission the GIDS clinic. It has announced the launch of two clinics for children with gender dysphoria by next spring, which will bring together multiple doctors from a broad range of specialities. The first, in London, will be based at Great Ormond Street Hospital and receive specialist mental health support from the South London and Maudsley NHS Foundation Trust. The second, in the northwest, will be led by a partnership between Alder Hey Children’s NHS Foundation Trust in Liverpool and the Royal Manchester Children’s Hospital. Cass said these new regional centres should focus on “child health and development”, bringing together existing services in mental health, autism and hormone treatment. She said there were “uncertainties about the long-term outcome of medical intervention” for children distressed about their gender, in particular the use of puberty blockers. Cass wrote: “We do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation. We therefore have no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process. “A further concern is that adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying [brain] function. “If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences. To date, there has been very limited research on the short, medium or longer-term impact of puberty blockers on neurocognitive development.” Cass said these clinics must have “established academic and education functions” to monitor evidence on children who are put on hormone therapy. The Tavistock clinic failed to collect sufficient data on the impact of puberty blockers in under-16s. She said there was “insufficient evidence” for her to make any firm recommendations around their routine use. Cass told the NHS to “enrol young people being considered for hormone treatment into a formal research protocol with adequate follow-up into adulthood, with a more immediate focus on the questions regarding puberty blockers”. Keira Bell took the Tavistock and Portman trust to court over the use of puberty blockers PAUL COOPER/REX FEATURES The NHS said it would launch clinical trials in partnership with the National Institute for Health and Care Research to follow children on puberty blockers into adulthood. “This will ensure that there is greater transparency for children and their parents/carers around the uncertain clinical benefits and longer-term health impacts surrounding their use,” a spokesman said. The clinic has been overwhelmed by a sudden increase in referrals, particularly among young girls and children on the autism spectrum. Last year it received more than 5,000 referrals, compared with 250 a decade ago. The Tory MP Kemi Badenoch, a former equalities minister, said she “cannot state enough how profound this decision is” to shut the Tavistock clinic. Writing on Twitter, she said: “There’s lots I can say now I’m no longer equalities minister — personal testimonies heard of destroyed childhoods, protecting whistleblowing clinicians from endless harassment by Twitter activists. “The battles fought to get the review going, the smearing of women who had serious concerns as terfs and bigots, how this links to wider problems such as the credulity of some MPs who allow policy-making to be subverted by groups including Stonewall.” Cass’s final report will be published next year. An interim review by Cass, published in March, found that services had developed without clear rules, and there was a “clinician lottery” with widely varying approaches to treatment. She found there was “a lack of agreement, and in many instances a lack of open discussion” about whether unhappiness with gender in adolescence was permanent or temporary. However, last year the Court of Appeal overturned a controversial ruling made by the High Court that under-16s were unlikely to be able to give informed consent to receiving puberty blockers. The case was originally brought against the Tavistock and Portman trust by Keira Bell, a 24-year-old woman who began taking puberty blockers when she was 16 before later “detransitioning”. Cass’s final report will be published next year. Her interim review published in March found that services had developed without clear rules and that there was a “clinician lottery”, with widely varying approaches to treatment. She found there was “a lack of agreement, and in many instances a lack of open discussion” about whether unhappiness with gender in adolescence was permanent or temporary. However, last year the Court of Appeal overturned a ruling made by the High Court that children under 16 were unlikely to be able to give informed consent to receiving puberty blockers. The case was brought against the Tavistock and Portman trust by Keira Bell, 24, who began taking puberty blockers when she was 16 to transition to male before later “detransitioning”.