Gender identity services switch to regional model after review

An ongoing independent review by past-president of the Royal College of Paediatrics and Child Health, Dr Hilary Cass into the country’s current gender identity services (GIDS), which is run by the Tavistock and Portman NHS Trust, has so far found that it is no longer “fit for purpose”.

She puts her findings down to a “complex and diverse” range of issues including a stark rise in the numbers of referrals over the past decade – more than 5,000 were made in 2021/22 compared with just 250 in 2011/12 – “scarce and inconclusive” clinical evidence and “staggeringly long” waiting times for initial assessments.

Following the recent publication of an interim report by Cass, NHS England announced the decision to close GIDS at London’s Tavistock Centre as well as the Trust’s endocrine services based in Leeds, replacing them with two early adopters of its new regional model by spring 2023.

Charities supporting young people with gender dysphoria “cautiously welcome” the idea of regional centres for GIDS, but raise concerns over whether such a tight timeframe could lead to further disruption for thousands of young people awaiting support.

Regional plans

The new model for delivering GIDS will be led by specialist children’s hospitals in London and North West England.

The London-based service will be formed as a partnership between Great Ormond Street Hospital for Children and Evelina London Children’s Hospital, with specialist mental health support provided by South London and Maudsley NHS Foundation Trust.

In the North West, a new service will be formed as a partnership between Alder Hey Children’s NHS Foundation Trust and Royal Manchester Children’s Hospital, which both provide specialist children and young people’s mental health services.

The new centres will differ from existing services because they will have “a multi-disciplinary team (MDT) of specialist clinicians so that assessment and care planning is delivered in an integrated way”, according to a guide to the reforms published by the Tavistock and Portman NHS Trust.

MDTs will include specialists in gender, paediatric medicine, mental health, autism and neuro-disability “so that a young person’s overall health needs are met holistically”, it adds.

Pros and cons

Charity Mermaids, which supports transgender, nonbinary and gender-diverse children and their families, says that a regional service will mean “more capacity in gender healthcare services and shorter waiting times” as well as “bringing services closer to home”.

It adds that the approach outlined by NHS England “addresses key issues we’ve raised continuously, including support for those on the waiting list, a diversity of pathways recognising each person has different needs and desires, and embedding support from the third sector”.

It highlights the need for a smooth transition for young people already under the care of the Tavistock and those awaiting referrals.

While the trust states that it remains “committed to achieving a smooth and seamless transfer for all patients”, Mermaids urges NHS England “to stick to their promise of a smooth transition, and ensure there is no further delay for those accessing gender identity services”.

Meanwhile, The Proud Trust, which supports LGBT+ young people, says the “design and delivery of any service needs to involve children, young people and their families from the start”.

NHS England says the two new regional centres are “just the first steps of a major transformation programme that will result in a network of specialist centres of expertise being established in every region of the country”.

Despite these pledges being what families have long called for, charities warn that failure to ensure a smooth transition for those undergoing treatment while the reforms take place could mean the changes do more harm than good.