Open and calm debate needed on young people and trans issues, says author

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The author of a book about a soon-to-close gender identity clinic for children has said she hopes the full story on how it worked can lead to “open, calmer debate” on transgender issues.

It was announced in July that the clinic at the Tavistock and Portman NHS Foundation Trust would be shutting down, with two services led by specialist children’s hospitals in London and the north west due to be established by spring this year.

The two new services are expected to be the “first step” in a regional network with the possibility that seven or eight services could be put in place.

An independent review, led by Dr Hilary Cass, was commissioned in September 2020 amid the rise in demand, long waiting times for assessments and “significant external scrutiny” around the London-based Gender Identity Development Service (GIDS) approach and capacity.

GIDS is the only NHS gender identity clinic in England and Wales for children and young people.

Dr Cass said there was a need to move away from a model of a sole provider and that the number of children seeking NHS help was “now outstripping the capacity of the single national specialist service”.

BBC journalist Hannah Barnes, who has written the book Time to Think, about what went wrong with GIDS, said there had been a “failure of leadership at all levels” across the service, the trust and NHS England.

In an interview with the PA news agency, she said: “One of the clinicians in the book puts it that almost there was a cloak of mystery around the service because it involved the word gender and several people have said (the word) gender just sort of muddied the waters.

“And so what should have been standard practice in any other clinical setting couldn’t be questioned. And yes, sometimes that was through fear of being branded transphobic.”

Publisher Swift Press said the book details how puberty blocking drugs were given to children as young as 10, before GIDS’ own research study had gathered or published any meaningful data.

It also says the service failed to routinely flag potential surgical difficulties from the early blocking of puberty; and how hundreds of older teenagers were “fast-tracked” to adult gender services after having had only one face-to face appointment.

Ms Barnes, who had led BBC Newsnight’s coverage of the care available to young people experiencing gender-related distress, said she wanted to “not tell people what to think, but present the evidence in the clearest and most robust way” in her book.

She said: “Certainly some young people were helped at GIDS, I absolutely make that point in the book, and I’ve spoken to some, but things have gone very badly wrong as well.

“And I think it’s really difficult to deny that and I think as we move forward and try to build these new gender services to help everybody, to have different pathways – medical transition for some, but certainly not for all – I think we can’t build better care going forward unless we learn from the mistakes of the past.

“And I also just wanted to bring it to a wider audience.

“I think if you’re the average, partly-engaged layperson, you might perhaps think that there’s consensus in the clinical community on how best to care for this group of young people, and where there is objection that it’s coming from a place of transphobia and nothing could be further from the truth.”

She said there is “no agreement amongst frontline clinicians on how best to treat this diverse, often distressed, often vulnerable group of young people, and that’s the same in gender clinics across Europe and in the United States”.

Asked what she wants people to take away from the book, she said: “I want there to be a more open, calmer debate about this whole area. Because of course, it’s about the trans community, but it’s about young people, it’s about children as well.”

She added: “I don’t want to tell people what to think and that’s why I’ve written it in the way I have and it’s up to them (the public) to make up their own minds, but I do hope they read it, because I think it’s a story of how some people have been harmed, and really people have been trying to tell us this for years and lots of people didn’t listen.”

In a statement, the Tavistock and Portman NHS Foundation Trust said: “GIDS works on a case-by-case basis with every young person and their family, working thoughtfully and holistically with them to explore their situation, with no expectation of what the right outcome for them might be.

“Only the minority of young people seen in the service are referred for any physical interventions.

“At the Tavistock and Portman we wholeheartedly support our staff to raise concerns, and have recently strengthened our mechanisms for doing so. Concerns relating to young people’s well being are taken seriously and investigated.”

The Cass review’s final report is expected this year.

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