The NHS has announced a radical plan to tackle the increasing numbers of children suffering gender identity crises — including six new specialist clinics and a trial of controversial puberty blockers involving teens.
The new regional centres join two existing clinics in Liverpool and London that replace the scandal-hit Tavistock Gender Identity Development Service, which shut its doors in July 2022.
Health chiefs said the new centres will focus on providing a more ‘holistic’ approach, including supporting mental health and kids with conditions such as autism.
NHS bosses will also tighten up the criteria for referrals to specialist clinics, with patients having to see two doctors beforehand.
More than 5,700 under-18s in England and Wales are currently on the national waiting list. There are currently two specialist hubs, which came into service last April.
Dr Hilary Cass said the length of the waiting list to access gender services had ‘significant implications’ for children and their families
Great Ormond Street Hospital in London is one of two hubs that replaced the scandal-hit Tavistock and Portman NHS Foundation Trust
The clinics — led by London‘s Great Ormond Street Hospital and Alder Hey Children’s Hospital in Liverpool — replaced the scandal hit Tavistock and Portman NHS Foundation Trust.
NHS England committed to transforming its gender identity services in the wake of the publication of the landmark Cass Review, in April this year.
The review concluded children given NHS transgender treatment had been set on a path to irreversible change despite scant medical data.
The move also follows a ban on the routine prescription of puberty blockers for children with gender dysphoria.
However, the controversial drugs, which pause the physical changes of puberty, will once again be available to children early next year, as part of clinical research trials.
The health service today said all new referrals to specialist gender services must be made through mental health or paediatric services to ensure every child or young person has had a thorough assessment of need.
The new services will have no minimum age requirement, in order to ensure that parents of very young children, as young as five, are given support through NHS services where necessary.
Alongside children and young people’s services, NHS England has also published plans for a review into adult gender services.
Dr Hilary Cass said she was ‘pleased’ the NHS was planning to ‘fully implement’ her recommendations, but warned that the process ahead is likely to be ‘challenging’.
She added: ‘I am pleased that NHS England is planning to fully implement the recommendations of my Review and the next important step will be the most challenging — turning it into a reality.
‘The vision of the Review — reflected in the implementation plan — is to increase available services for gender-questioning young people which take a holistic approach to care addressing the needs of each individual, and which put in place a full package of care which can be delivered as close to home as possible.
‘Setting up a new collaborative of regional providers will also bring in leaders from professional societies, education, and research, to ensure these services continue to develop in line with evidence and best practice to support children and young people.’
Professor James Palmer, NHS medical director for specialised commissioning, said: ‘The roll out of new specialist centres in every region across England will be central to improving and expanding NHS gender services for children and young people, to ensure that they receive evidence-based, responsive, holistic care — and the Cass Review is the backbone on which our implementation plan is based.
‘It’s clear that our services for adults need focus too. The waiting times for care are too long and experiences of care are too variable.
‘The review needs to address poor experience but also learn from good experiences of care.
Puberty blockers, which pause the physical changes of puberty, will now only be available to children as part of clinical research trials. Pictured, Tavistock and Portman NHS Foundation Trust, which has been accused of rushing children onto puberty blocking drugs by former patients
‘It’s vital we hear from patients and staff, some of whom have raised concerns to Dr Cass, and this review will be a further opportunity for them to be heard.
‘There remains considerable work to do, but we are already making progress on a number of Dr Cass’ recommendations, and our plans published today set how we will establish services that provide the care that patients and their families need to thrive.’
Previously, the only NHS clinic providing gender services for children was the Tavistock and Portman NHS Trust in London.
It was criticised for its approach which relied heavily on medical intervention, using puberty blockers to delay the onset of puberty, despite a lack of evidence the medication had a positive impact.
Its services had previously been rated as inadequate by inspectors in January 2021.
Dr Cass’s review also found GPs were ‘pressurised to prescribe hormones’ by patients who had seen a private clinician.
The report, which ran to nearly 400 pages, issued a stern warning over ‘the use of unregulated medications and of providers that are not regulated within the UK’.
And Dr Cass said GPs should resist attempts by private providers to prescribe puberty blockers or hormones, ‘particularly if that private provider is acting outside NHS guidance’.