Keira Bell
© DailyMail/YouTube
The Tavistock clinic faces a complete overhaul after a review found that its gender identity services are "not a safe or viable long-term option" for children and young people.

The report has been hailed as a victory for whistleblowers who warned that the gender identity development service (GIDS) clinic in north London was operating outside of typical NHS safeguarding and clinical standards.

Dr Hilary Cass, a retired paediatrician, was commissioned by NHS England to investigate services at the clinic, which has been sending children as young as ten for experimental hormone treatment.

The clinic, run by the Tavistock and Portman NHS Foundation Trust, is England's only specialist service for children and young people who identify as transgender.

It has been overwhelmed by a sudden increase in referrals from across the country, particularly among young girls who are distressed about their gender and youngsters on the autism spectrum.

In 2009 the clinic received about 50 referrals — typically from males who had suffered gender dysphoria from an early age. By 2020 there were 2,500 referrals, mostly from females who started suffering gender identity issues in their early teens, with a further 4,600 young people on the waiting list.

Comment: So in 11 years there has been a 5000% increase in referrals!?

About one third of children and young people referred to GIDS have autism or other types of neurodiversity, while there is also an over-representation of "looked after" children in local authority homes or foster care.

It has also lost many senior staff who have clashed with the leadership over the best way to treat vulnerable young people with complex histories who are requesting experimental hormone therapies to change gender. The long-term outcomes of such therapies in this age group are still unknown.

Critics have accused the clinic of abandoning NHS best practice in its alleged readiness to offer life-changing medical treatments to children who declare themselves transgender.

Cass concluded that a "fundamentally different service model is needed" in an interim report released yesterday.

Her report calls for the end of the clinic's current monopoly over treatment of young people wishing to change gender.

She recommended that treatment be redistributed to regional hubs across the country, to reduce the burden on the north London clinic and to ensure that young people in crisis are seen more quickly, by a broader range of health professionals.

Comment: Hopefully this will include mental health professionals, preferably non-woke ones.

Cass said that GIDS's lack of consistent data collection meant that not enough is known about service users or their outcomes to justify the current approach to treatment.

She also found that the treatment of young people identifying as transgender had somehow escaped the "normal quality controls".

"Because the specialist service has evolved rapidly and organically in response to demand, the clinical approach and overall service design has not been subjected to some of the normal quality controls that are typically applied when new or innovative treatments are introduced," the review said.

The report concluded: "A fundamentally different service model is needed which is more in line with other paediatric provision, to provide timely and appropriate care for children and young people needing support around their gender identity. This must include support for any other clinical presentations that they may have.

"It is essential that these children and young people can access the same level of psychological and social support as any other child or young person in distress, from their first encounter with the NHS and at every level within the service."

Cass prefaced her report with a letter to young people. She said: "I have heard that young service users are particularly worried that I will suggest services will be reduced or stopped. I want to assure you this is absolutely not the case — the reverse is true. I think that more services are needed for you, closer to where you live."

Critics of the clinic have said that rapidly changing social attitudes to transgender identity have led it to operate beyond the usual safeguarding standards that apply to every other part of the health service.

Kate Grimes, a retired hospital manager, said she felt "relief that finally the NHS is looking at this seriously. Relief for the patients currently being harmed. Relief for the staff who have felt unable to speak out. And hopeful that we can now start to get a proper service model in place and that we can reintroduce the basics of quality care for patients — using evidence, gathering data, listening to staff."

Grimes, who has written publicly of her concerns about GIDS, expressed regret that "it had been left for so long and had got to the point of patients taking legal cases and whistleblowers going to court before the review was finally commissioned to tell us something that the NHS should have known and been looking at for years now".

Dr Anna Hutchinson, a clinical psychologist who left GIDS amid concerns that young people were being sent for life-changing hormone treatment without adequate investigation of other factors that may be the cause of their identity crises, welcomed the calls for "better standards of care for gender questions and trans-identified young people which we can all agree is necessary."

The report, she said, "reminds clinicians that supporting young people experiencing distress with their gender is 'everybody's business' not just that of specialist practitioners".

A GIDS spokeswoman said: "The Tavistock and Portman NHS Foundation Trust welcomes the focus of Dr Cass and her team on increasing and broadening the care and support available for this group of patients who are currently waiting far too long and on developing the evidence base. We will work with her and NHS England to support her recommendations."

The Cass review is expected to make formal recommendations at a later date.
tavistock time line
© The Times
Keira Bell 3

At the Tavistock, Ms Bell (pictured outside the Royal Courts of Justice in January) says, there was 'no resistance' to her want to be a boy, even though she was little more than a child
When Keira Bell was 14, she says she was "really struggling with puberty and my sexuality", and "had no one to talk these things through with".

She told the Woman's Place UK website: "When I stumbled upon transsexualism, that was me — I was meant to be a boy. It made absolute sense to me and I related so strongly to those women [online] that had started to undergo medical transition. I felt that I needed to start with medical transition as soon as possible in order to achieve my happiness." She went to the Tavistock and Portman clinic, and was put on a pathway to that end.

She says initial consultations were superficial and did not discuss her sexuality, describing "very general, surface-level stuff. 'What is your preferred name? Do you want to transition?'".

At 16 she began taking puberty blockers, and by the age of 20 had undergone a double mastectomy.

But she now regrets that transition and lives as a lesbian woman. Aged 23, she began pursuing a judicial review of the NHS trust. She now argues children going to the clinic should not be treated under an "affirmation model".

The High Court initially ruled in her favour, deciding that teenagers could not give consent to transition. The Court of Appeal overturned that ruling in September. Bell said at the time that she intended to pursue it further and would seek leave to appeal to the Supreme Court.