England’s health regulator will take enforcement action against private clinics that prescribe puberty blockers to under-18s in defiance of the NHS’s ban on the controversial drugs.
The Care Quality Commission (CQC) will check that private providers of care to those who are questioning their gender identity are applying new guidance recommended by Dr Hilary Cass.
In an important report this week Cass warned that puberty blockers have not been proven to reduce gender dysphoria or improve body satisfaction, may damage a teenager’s ability to think and reason and also that the rationale for suppressing puberty at all “remains unclear”.
The ex-president of the Royal College of Paediatrics and Child Health made clear her view, which NHS England had already adopted last month, that they should no longer be given to anyone under 18 on safety grounds.
The CQC plans to ensure that Cass’s approach is being followed by private clinics, not just the NHS, amid concern from doctors and campaigners that for-profit outfits may seek to keep prescribing the drugs and create a “two-tier” approach to the drugs, with access dependent on wealth.
There is a risk that “a very dangerous loophole” will allow private clinics to cash in on the demand from gender-questioning young people to get access to puberty blockers, one doctor who backs Cass’s plan for sweeping changes in transgender healthcare said.
In future, to prevent that from happening, the regulator will check if licensed healthcare providers are “taking into account the recommendations of the Cass Review” when it registers and inspects them. Any private clinic found to be issuing puberty blockers to anyone under 18 could be disciplined by the CQC if a prescription was found to be a breach of their legal duty to provide “safe care and treatment”, based on the evidence Cass analysed in her three-and-a-half-year-long inquiry.
“If a private organisation registered with the CQC fails to meet the condition of its registration, then the regulator can take enforcement action,” a Whitehall source said.
The CQC has an array of regulatory powers at its disposal including, as a last resort, withdrawing the registration which grants legal permission for a provider to operate.
Victoria Atkins, the health and social care secretary, made clear on Thursday that private providers would not be allowed to avoid adhering to the new treatment approach Cass proposed.
Writing in the Daily Telegraph, she said: “I am clear in my expectation that private providers must fall in line too [with the NHS’s new approach to puberty blockers].”
But some doubt remains as to whether guidelines devised for the NHS can be made mandatory for private clinics too. “The CQC will expect all private providers to take into account the Cass recommendations. But they don’t have to. Private providers aren’t bound by Cass’s recommendations,” a source explained.
However, at present no CQC-registered private gender care clinic issues puberty blockers.
A CQC spokesperson said: “Best-practice guidance for gender identity clinics will be considered by internal specialist advisers during registration and regulatory assessments.”
One clinic, Gender Plus, run by the clinical psychologist Dr Aidan Kelly, offers cross-sex – masculinising or feminising – hormones to 16- to 18-year-olds but does not provide puberty blockers. Doctors should exercise “extreme caution” before issuing cross-sex, or “affirming”, hormones to under-18s, Cass said in her report.
Sue Evans, a psychotherapist and mental health nurse who used to work at the Tavistock and Portman NHS mental health trust, which hosted the controversial gender identity development service (Gids) for gender-confused children and young people, is challenging the legality of the CQC’s decision in January to recognise Gender Plus’s hormone clinic as a provider of health care.
