Schools should not allow gender-questioning children to “socially transition” without their parents’ involvement, according to NHS training and guidance on how staff should respond to pupils exploring their gender identity.
The new online module published by NHS England represents the first national guidance on how to support children with gender-related questions or distress in education settings.
Some school leaders described the NHS material as helpful in contrast to the “vacuum” left by the government’s failure to publish its long-overdue guidance, which Rishi Sunak had promised would be ready earlier this year.
NHS England said the training resources were developed independently of the Department for Education (DfE) and were not intended to influence policy. The material was put together because a need had been identified for additional guidance, a spokesperson said.
The course states: “Recently, there has been a rise in young people asking to make a social transition at school or college without the knowledge or involvement of their parents or carers.”
It defines social transition as allowing a child to adopt a new gender and might involve a school agreeing to refer to the child using a different name and pronoun, or authorising the use of different toilets and facilities.
The training module advises: “Supporting a social transition without the involvement of parents or carers can create complex difficulties within families and is not recommended. Secrets between parents or carers and their children are problematic and are likely to create further issues in the future.”
It adds: “The priorities of parents and carers should be held as central, so that decision-making is collaborative.”
While organisations that advocate for transgender, non-binary and gender diverse children agree that families or carers should be closely involved in social transition, some argue that potential safeguarding concerns mean schools should be cautious about involving families by default.
The NHS’s position aligns with reports of the government’s draft guidance, which is said to advise that schools should inform parents and seek their consent to allow a child to socially transition. But some ministers and MPs have been pushing for a legal ban on children socially transitioning.
Geoff Barton, the general secretary of the Association of School and College Leaders, said it was important that the NHS and DfE guidance were consistent when they were both eventually published.
“It’s helpful that the NHS is providing guidance as this is obviously a source of information in which educators can have a high degree of confidence in navigating this complex and sensitive territory,” Barton said. “The frustration is that there continues to be a vacuum in terms of the official guidance that is supposed to be coming from the Department for Education.
“This is such a highly charged subject that schools and colleges are likely to find themselves under fire whatever decision they make and they really do need to be able to point to the fact that they are following official guidance. At the moment – and for many years – this has not been the case, and the government has just left them hung out to dry.”
The NHS England guidance restates the NHS’s position, set out by the Cass review on gender identity services, that social transition is an “active intervention” rather than a “neutral act”. It also notes that “there are lots of unanswered questions from research in relation to the benefits and potential consequences of social transition on mental health and wellbeing”.
Teachers with “significant concerns” about negative responses from parents should seek “safeguarding oversight”. Staff are advised: “Make referrals to additional support agencies if levels of conflict within the family seem high, cannot be resolved with your input, and are potentially harmful.”
Topics are suggested for possible “supportive” discussions between teachers and children and their families to explore the pros and cons of social transition, encouraging staff to ask if there are “broader wellbeing concerns that seem to be driving the request”, and to discuss if there are gradual steps that can be taken towards making a change, “for example, changing hair or clothes first, before making more formal changes to name and pronouns in school or college”.
The online training says the resources “present a shared understanding across the NHS and have been through an extensive peer review process”.
The module for school staff was launched alongside separate courses for healthcare professionals, including one that spells out the NHS’s position on prescribing puberty-suppressing treatment or masculinising or feminising hormones to young people who are considering transition.
“Young people seeking hormone interventions must weigh up a complex set of possible benefits and risks. The research on long-term physical and mental health outcomes of medical intervention is limited,” it states.
Gillian Keegan, the education secretary, told MPs in July that the government’s own guidance for schools in England would be delayed to allow more time to consult lawyers, parents and teachers.
“In the meantime, schools and colleges should proceed with extreme caution. They should always involve parents in decisions relating to their child, and should not agree to any changes that they are not absolutely confident are in the best interests of that child and their peers,” Keegan said.
