Five thousand children and adolescents with gender-related distress are awaiting NHS treatment – yet a shortage of clinicians meant only 12 had been seen at a new London-based gender clinic by the start of this week.
Two newly opened gender centres, in London and Liverpool, are looking at “creative ways” of reducing the waiting lists, such as running group sessions with therapists, according to Hilary Cass, the consultant paediatrician who has devised the new, more holistic treatment model for children and adolescents questioning their gender identity.
Only half of the required 45 members of staff have been hired to work in a London clinic that does not yet have a building, leaving patients to be seen online, according to a spokesperson for Great Ormond Street hospital, which is responsible for setting up the London clinic which opened on 2 April.
The Cass review states that there have been “considerable challenges” in setting up these clinics within a “highly emotive and politicised arena”.
About 250 children and adolescents have been transferred to the care of the new London hub – which will be called the Children and Young People’s Gender Service, London – and the second clinic in the north-west. Only a handful of patients are understood to have been seen so far in the north-west clinic.
Cass acknowledged that it would “take a while to resolve” the long waiting list, but said child and adolescent mental health services (Camhs) were screening children on the list to flag “urgent problems and urgent risks”.
She said there was “no magic fix” for getting the waiting list down, other than investment in Camhs and recruiting more staff into mental health services. Waiting lists would come down when more children and young people were seen by generalist practitioners locally, rather than being placed on a waiting list for specialist gender services, she said.
Clinicians’ nervousness about working in this area has made recruitment to the new services very challenging, Cass said, describing how some healthcare staff were “fearful” of working in this field, partly because of uncertainties about the correct treatment model and partly because they feared “being called transphobic if you take a more cautious approach”.
NHS England said helping the new clinics to “overcome challenges around staff recruitment will be a top priority as this will determine the pace at which they will be able to see new patients from the waiting list”.
The Great Ormond Street hospital spokesperson said a consultant paediatrician and consultant psychologist were already leading the hub’s multidisciplinary team. “We have been actively recruiting since November 2023. Building a workforce is taking time as we are recruiting into disciplines where there are known shortages, such as doctors and psychologists,” he said.
No staff members who worked at the Tavistock’s now-closed gender identity development service had been hired for the new clinics, he said. The Cass review sets out that when the hubs are operating at full capacity they should be staffed by clinicians from mental health services and services for children and young people with autism and other neurodiverse presentations. There should also be support for looked-after children and children who have experienced trauma.
Cass’s new model aims to move services away from having a very specialist focus; she said no one in the team “should have a tunnel vision on gender” and that clinicians should continue to work in parallel in other parts of the NHS outside the gender hubs.
“The more we can bring this back into normal adolescent care the better,” she said.
“It is about seeing people as whole people; if they need to go on a hormone pathway, then that’s fine and that should be still available embedded in the services,” Cass said this week. Access to endocrinology services and fertility services should be available for the minority of patients whom Cass expects to go on to seek a medical intervention.
Cass said she had an encouraging conversation with the clinical lead for the new London hub last weekend, who said a “very diverse range of young people” had been seen, and that the patients had been “very pleased” that they would have access to a broad range of services.
Great Ormond Street’s spokesperson said: “We are working swiftly on recruiting the right skill mix of people … We aim to settle into a permanent community base as soon as possible so we can provide the best possible service.”
He said the group sessions were not specifically designed to reduce waiting lists, adding that “group sessions and workshops have additional benefits in decreasing isolation and increasing a sense of social support for isolated young people and their families”.
“Families we have spoken to have expressed their appreciation for this opportunity. These will not be the only interventions offered and will be part of a bespoke package of care tailored to the individual needs of young people and their families,” he said, adding that there would be some one-to-one options for those children unable to access group interventions.
The central aim of the new services is “to help young people to thrive and achieve their life goals”, the Cass review states.
Mermaids, a transgender youth support charity, said it was “pleased the voices and experiences of trans young people appear to have been heard and respected” in the review, but added that the NHS was “failing trans youth, with appalling waiting lists” amid “increased politicisation of the support offered to children and young people”.
The mother of one teenager who referred herself on to the waiting list for care at the Tavistock gender clinic but who never progressed close enough to the top of the list to receive an appointment said she thought her daughter would benefit from the new approach.
“This looks like normal healthcare,” she said. “Sometimes it has felt like trans-identifying children have been exempted from all normal rules – in schools, and in healthcare. I just want her to receive standard NHS healthcare, with a strong mental health element.”
