Gender identity development service for children rated ‘inadequate’ by inspectors
Thursday, January 21, 2021
The UK’s largest gender identity service for children has been rated ‘inadequate’ by the Care Quality Commission amid concerns young people at risk of self-harm are waiting up to two years for treatment.
The Tavistock and Portman NHS Foundation Trust, which runs the Gender Identity Development Service (GIDS) through clinics in London and Leeds, faced immediate enforcement action following a visit from inspectors in November.
The report, published this week, notes that the service is “difficult to access” meaning more than 4,600 young people were waiting for treatment at the time of the inspection.
The average waiting time for initial appointments was around 18 months with some patients waiting two years, it adds.
Staff “did not always assess and manage risk well” despite many patients waiting for an initial appointment being recognised as at increased risk of self-harm, inspectors say.
“The size of the waiting list meant that staff were unable to proactively manage the risks to patients waiting for a first appointment. For those young people receiving a service, individual risk assessments were not always in place with plans for how to manage these risks,” the report states.
It also adds that high caseloads placed added pressure on individual staff members, impacting on care and risk-management for children. A third of staff members had caseloads of 60 patients at any one time, the report shows.
Inspectors also criticised the leadership of the service, stating it was “not consistently well led” and staff did not always feel respected, supported and valued, while some said they felt unable to raise concerns without fear of retribution.
Concerns were raised about record-keeping at the service before January 2020, following the CQC’s last inspection at the clinic in 2016.
“Staff had not consistently recorded the competency, capacity and consent of patients referred for medical treatment before January 2020. However, since this date these decisions had been recorded,” it states.
Inspectors further noted that “records of clinical sessions did not include any structured plans for care or further action”, and questioned the standard of ongoing care for patients, stating: “Staff did not develop holistic care plans for young people.”
However, inspectors rated the quality of care delivered by the service as “good”, adding that feedback from young people and families being seen at the service was overwhelmingly positive about the care and support provided.
The report was published as the trust was granted leave to appeal a High Court ruling which barred it from referring under-16s for treatment involving puberty blockers.
A spokesman for Tavistock and Portman NHS Foundation Trust said: “We take the CQC’s report very seriously and would like to say sorry to patients for the length of time they are waiting to be seen, which was a critical factor in arriving at this rating. We know the difficulty this wait is causing them and their families and we agree with the CQC that the growth in referrals has exceeded the capacity of the service.
We very much accept the need for improvements in our assessments, systems and processes. In addition, we have submitted our plan to improve the management of our waiting list to the CQC and are working with our commissioners, NHS England, and others to improve access to the service. We are determined to get this right for children and young people and will be agreeing a full action plan with the CQC to address further concerns.
“Above all, we remain focused on providing a high quality service to children and young people in our care and supporting our staff who, despite the challenging context they have been working in, have been praised by the CQC for their understanding, compassion and kindness. Patient feedback was reported as overwhelmingly positive and we will involve both patients and staff as we build on these strengths.
"The Tavistock and Portman NHS Foundation Trust is committed to providing high quality care to patients and its overall rating remains ‘good’.”