Review Launched Into Gender Identity Service for Young People

Peter Russell

September 23, 2020

The NHS has launched an independent review into gender identity services for children and young people.

The review is a response to a significant increase in the number of referrals to the Gender Identity Development Service (GIDS) run by the Tavistock and Portman NHS Foundation Trust.

Referrals to the GIDS centre have been increasing each year from just 77 in 2009-10 to 2590 in 2018-19.

Terms of reference for the review said that the increase in referrals had come at a time when the service moved from a psychosocial and psychotherapeutic model to one that also prescribes medical interventions through the use of puberty blocking and cross sex hormone drugs. Those treatments had heightened interest in how the NHS should be caring for children and adolescents who presented with gender identity issues, NHS England said.

The review will be led by Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health. Dr Cass said: "It is absolutely right that children and young people, who may be dealing with a complexity of issues around their gender identity, get the best possible support and expertise throughout their care."

CQC Inspection

Separately, the Care Quality Commission (CQC) is due to carry out a focused inspection of GIDS during the autumn. The inspection will cover parts of the safe, effective, caring, responsive, and well-led key questions, and will include feedback from people using the service, and staff.

Dr Cass is also due to review the service's clinical practice.

The Tavistock said it welcomed the independent review and the CQC inspection. It acknowledged that as referrals had risen, the service has struggled to meet demand and young people were being let down while they waited for care.

Paul Jenkins, chief executive of the 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."

Professor Helen Stokes-Lampard, chair of the Academy of Medical Royal Colleges said: "This is a multi-professional issue and we are pleased that a formal review is taking place to provide a comprehensive, evidence-based view on this sensitive and complex subject."

'No Change' to Gender Recognition Law

Meanwhile, the Government said on Tuesday that it would not allow transgender people to change their legal gender through self-identifying.

The decision was announced by Liz Truss, minister for equalities, in response to a consultation on the Gender Recognition Act 2004.

"It is my view that the balance struck in the existing legislation is correct," she said. "There are proportionate checks and balances in the system, alongside support for people that want to change their legal sex."

Instead, the Government pledged to overhaul the process of applying for a Gender Recognition Certificate (GRC) by digitising the application form on and "significantly" reducing the fee for the application from the current £140.

Ms Truss said that funding for gender identity services had increased by 50% over the last 3 years, with at least three new gender clinics opening in the current financial year.

She also said that the UK's first national LGBT health advisor would take action to address problems caused to people subjected to long waiting times for specialised gender identity services.

The announcement means that GRC applicants must continue to provide a medical diagnosis of gender dysphoria from a qualified medical practitioner, and a medical report from an approved medical professional providing details of any treatments. They must also supply evidence that they had lived in their acquired gender for at least 2 years.

Nancy Kelley, chief executive of Stonewall, which campaigns for equality for gay, lesbian, and trans people, commented: "The current process for obtaining legal gender recognition is burdensome, bureaucratic, and demeaning – and as a result, most trans people simply don't feel able to engage with it.

"Stonewall, along with many other trans-led and trans-inclusive organisations, have been campaigning for a de-medicalised, straightforward process for legal gender recognition. This isn’t groundbreaking – our neighbours in Ireland have had a similar system in place since 2015 with no negative consequences, and plan to further improve the process for trans people."


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