Better gender identity support
Derren Hayes
Tuesday, October 27, 2020
Charities call for gender identity service review to tackle waiting lists and hear children’s experiences.
An independent review of gender identity services for children in England must tackle the significant obstacles young people and their families face in accessing support, charities have said.
In September, the NHS revealed details of the wide-ranging review, which was initially announced in January but was delayed due to the Covid-19 pandemic. It will be led by Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health, and will focus on how care can be improved for children and young people.
Key issues the review will investigate include how and when children are referred to specialist services, clinical decisions around how doctors and healthcare professionals support and care for young people with gender dysphoria, and factors behind the recent rise in referrals to specialist services.
Waiting times
The Gender Identity Development Service (GIDs) for children and adolescents, managed by The Tavistock and Portman NHS Foundation Trust, is the only NHS provision of its kind in England and Wales. It includes counselling and psychological support, and in some cases can include the prescribing of puberty blockers and, from the age of 16, cross-sex hormones.
The waiting list for a first appointment at GIDs is around 18 months, four-times longer than the 18-week maximum target for non-urgent consultation-led treatments set out in the NHS Constitution.
Tackling the lengthy waiting list is crucial to improving provision for children and young people, says charity Stonewall.
Kirrin Medcalf, head of trans inclusion at Stonewall, says: “It’s important all young people who are questioning their gender identity are able to access high-quality, appropriate, and timely care. However, many young people and their families who rely on services like the Tavistock face significant barriers in accessing support, including extremely long waiting lists and obstacles to referral. This means that many young people and their families are being left without the support, advice and care that they need.”
Mermaids, a charity that supports transgender young people, says that the long waiting times can have profound effects on young people.
In a statement, it says: “We are aware that some young people are waiting as long as 28 months from referral for their first appointment, when they should be waiting no longer than 18 weeks. This pressure often leads to great anxiety for children, young people and their families and we trust the thorough review will acknowledge the urgent demand for increased and diversified provision, proportionate to need.”
The long waiting times are linked to a rise in referrals to GIDs in recent years – in the five-year period to April 2020, the total number of children and young people referred almost doubled from 1,408 to 2,728 (see graphics).
The Tavistock admits the service has been unable to keep pace with demand, with negative consequences for children. “As referrals have risen, the service has struggled to meet demand and young people are being let down while they wait for our care,” it said in a statement.
GIDs has been the subject of critical media coverage in recent years linked to a leaked internal report that questioned some clinical practice.
In January, a judicial review was launched into the use of puberty blockers. The case, which was heard last month, was brought by a detransitioned young women who underwent treatment at GIDs on the grounds that children cannot give informed consent to receive such treatments.
In addition to Dr Cass reviewing GIDs’ clinical practice, the Care Quality Commission is set to undertake a focused inspection to assess how “safe, effective, caring, responsive and well-led” the service is.
In a statement, the Tavistock said the care of gender diverse children and young people is “complex and highly specialist”, and is “proud of the work of GIDs and the care it provides working to a national specification set by NHS England”.
Paul Jenkins, chief executive of the Tavistock and Portman NHS Foundation Trust said: “We look forward to the opportunities to demonstrate the quality of the care we deliver, the thoughtfulness of our clinicians, and their resilience in this difficult field of work. We welcome the wider review of pathways and hope it will lead to better and quicker access to support for the young people who need help.”
Improvements in care
However, Stonewall’s Medcalf says improvements in care for trans children are needed “without a doubt”.
“One way to do this would be to make sure all health and social care staff are trained to understand how they can better meet the unique needs of trans patients, so we have better primary care,” he says.
“It’s also vital that service providers listen to the voices of a diverse range of trans young people so they can make sure they’re getting it right.”
Mermaids also says it is vital for the independent review to prioritise the views of young people.
“We welcome the broadening of this independent review of the GID’s important work,” it states. “We call for transgender, non-binary and gender-diverse voices to be placed at the core of the report. If children and young people are to benefit from a better-provisioned service, the review must be based on clear evidence and lived experience.”
The review will publish recommendations on how to improve services for young people in 2021.