Staff at trans clinic fear damage to children as activists pile on pressure Andrew Gilligan in The Times 16.02.19

The original article is here.

England’s only NHS gender clinic for children is exposing young patients to “long-term damage” because of its “inability to stand up to the pressure” from “highly politicised” campaigners and families demanding fast-track gender transition, some of its own doctors say.

The Gender Identity Development Service (Gids), part of the Tavistock and Portman NHS Foundation Trust in north London, is providing “woefully inadequate” care, according to a report by a senior clinician and former governor of the trust. Some staff have “very serious ethical concerns” about children making life-changing decisions with “inadequate” examination and consent.

An official review drawn up in response to the report accepts some criticisms and makes 26 recommendations. However, Gids insisted that the service was “safe and operating in line with best practice internationally” and there was no evidence of poor care.

The report was compiled late last year by David Bell, then staff governor, whose role was to present staff concerns. It says some children “take up a trans identity as a solution” to “multiple problems such as historic child abuse in the family, bereavement . . . homophobia and a very significant incidence of autism spectrum disorder” after being “coached” online and by trans activist groups.

The true histories of “highly disturbed or complex” child patients were not properly explored by Gids clinicians struggling with “huge and unmanageable caseloads” and afraid of being accused of transphobia if they questioned the “rehearsed” surface presentation. The report says the concerns voiced by staff are shared by Sonia Appleby, who is in charge of safeguarding at the trust.

Some youngsters were referred for puberty-blocking hormones — which are usually followed at 16 by cross-sex hormones causing irreversible change and lower fertility — after just one session, the report says. The trust denied this.

Examples of cases in the report include a girl from a family with a history of abuse of females. The mother’s anxiety about having a daughter was transmitted to her child, who resolved to change gender. Another girl felt “deeply guilty” after her brother died tragically, so she decided to give her parents “their son back” by changing gender. Some openly homophobic parents sought transition for their children because they were gay.

In other cases, uncomfortable feelings that are normal for adolescents are being “relabelled as to do with wishing to change gender, a position . . . which the service is unable to challenge”. Gids has “close relationships with organisations that are identified as part of the pro-trans lobby such as Gendered Intelligence and Mermaids, and [went] to some lengths to placate them,” the report says.

Gids sources pointed out that Mermaids, a charity that campaigns for children to be given sex-change treatment, has been critical of the service, falsely claiming that its refusal to treat children more quickly leads many to attempt suicide. “We are caught in the middle,” one staff member said. “We are accused of going too quickly by some people and too slowly by others.”

Ministers have expressed concern after the number of children referred to Gids rose by 700% in the past five years, from 314 to 2,519 — almost three times the rise for adult gender transition.

The report says clinicians felt a pressure to “process referrals rapidly” rather than “develop any deeper understanding of the children and their families”. It triggered a review by the trust’s medical director, Dinesh Sinha. The trust’s board considered both documents last week.

Sinha’s review says Gids has “significant strengths” and most staff feel diagnosis is given “a significant degree of thought”, but staff caseloads were “excessive” and there were “repeated concerns from a minority of clinicians about being subject to bullying”. Lobbying by pressure groups created “an atmosphere of significant persecution”. Several staff were unsure whether young people truly understand “issues such as fertility and its impact on their adult lives”. Gids’ leadership was “unable to act, due to the intense scrutiny”.

The Bell report is sympathetic to children questioning their identity but says many “have learnt through online resources [or] coaching from parents or peers exactly what to say in order to get the results they want”. Some children had “virtually no freedom to express their own view”.

One staff member says: “You suddenly see groups of kids who at initial interview give exactly the same version of transition decisions, reasons, etc . . . I have overheard them in the corridor, parents coaching children before the interview and chiding them. I feel I have let down a large number of children.”

This weekend the trust said its medical director had “found the service to be safe and operating in line with the best practice in this field internationally. He did not find evidence to support the concerns raised about standards of care. In the light of the review, the trust is developing an action plan to enable it to meet current demand and future challenges.”

@mragilligan