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NHS England will move young people who believe that they are trans into regional centres which will take a more “holistic” approach to treatment and look at other mental health or medical issues they may have.
The decision is a response to the interim Cass Review, which warned that medics in the Tavistock had felt “under pressure to adopt an unquestioning affirmative approach” to gender identity rather than going through the normal process of clinic assessment with young people.
Dr Hilary Cass, the consultant paediatrician who is leading the independent review, found earlier this year that the clinic as the only provider of gender identity services for young people in England was “not a safe or viable long-term option”.
Announcing their response to Dr Cass's recommendations, NHS England said that “given the urgent requirement to stabilise current service provision” they will establish two “Early Adopter services” run by specialist children’s hospitals.
Clinic to close by next spring
The centres, one in London and one in the North West, will take responsibility for all of the Tavistock clinic’s patients and waiting lists with the aim to shut down the clinic by next spring.
NHS England have also committed to follow Dr Cass’s recommendation that they carry out “rapid” research on the use of puberty blockers by young people after it was noted there is currently “insufficient evidence” on their impact.
NHS England have also committed to follow Dr Cass’s recommendation that they carry out “rapid” research on the use of puberty blockers by young people after it was noted there is currently “insufficient evidence” on their impact.
The Cass review was commissioned by NHS England in 2020 amid concerns that there was “scarce and inconclusive evidence to support clinical decision making” which saw children as young as 10 given puberty blockers.
There were concerns over a sharp rise in referrals to the Gender Identity Development Service (GIDS) run by the Tavistock and Portman NHS Foundation Trust – over 5,000 in 2021/2 compared to 250 a decade earlier and long waiting lists.
Dr Cass, a past president of the Royal College of Paediatrics and Child Health, was also asked to investigate the “marked changes” in the patients being referred from those who are born men wishing to become women to girls in their early teens claiming that they were born in the wrong body.
A spokesman for NHS England noted that there were “a significant number of children are also presenting with neurodiversity and other mental health needs and risky behaviours which requires careful consideration and needs to be better understood”.
It was amid fears that doctors were too quick to affirm a child’s new identity, without looking at other mental health or medical issues, that Dr Cass recommended moving away from a single provider model.
The NHS said that it recognised the need to “establish regional services that work to a new clinical model that can better meet the holistic needs of a vulnerable group of children and young people”.
Recommendations to be released
New recommendations from the Cass review, due to be released on Thursday, state that “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’.
Initially two clinics will be set up, one in London led by a partnership between Great Ormond Street Hospital and the Evelina London Children’s Hospital and a second in the North West, led by a partnership between Alder Hey Children’s NHS Foundation Trust and the Royal Manchester Children’s Hospital.
The NHS hopes to eventually run around eight regional centres.
“The ongoing work of Dr Cass’ review, alongside our experience in establishing the Early Adopter services, will help shape the development of the new model of care, national standards and a new national service specification against which regional services can be commissioned,” an NHS England spokesperson said.
“We will engage and consult fully on this service specification in due course.”
