The NHS is shutting down its gender identity clinic for children at the Tavistock and Portman NHS foundation trust after it was criticised in an independent review.
Regional centres would be set up to replace the service and “ensure the holistic needs” of patients are fully met, NHS England said, after being warned that only having one provider was “not a safe or viable long-term option”.
The Tavistock clinic, named the Gender and Identity Development Service (Gids), was launched more than three decades ago to help children and other young people struggling with their gender identity.
But in recent years, concerns have repeatedly been raised about the service. Inspectors rated it “inadequate” after complaints raised by whistleblowers, patients and families.
The service was criticised for its care of patients both inside and outside the clinic, and it also had record waiting lists. Doctors reported concerns that some patients were referred on to a gender transitioning pathway too quickly.
“The aim is to close the Tavistock clinic [the Gender and Identity Development Service (Gids)] by spring 2023, moving to the new provider model through specialist children hospitals,” a senior NHS source told the Guardian. There will be no immediate changes for patients already under the Tavistock’s care, according to the source. “The children being seen by the Tavistock (and those on waiting lists) will be transferred to a new provider over the course of that time.”
In a statement, NHS England said it intended to build a “more resilient service” by expanding provision, and would establish two services led by specialist children’s hospitals in London and north-west England.
It followed recommendations from Dr Hilary Cass, who is leading an independent review of gender identity services for children and young people.
She said there was a need to move away from a model of a sole provider, and instead establish regional services to better meet patients’ needs.
In her interim report, released in March, she wrote: “It has become increasingly clear that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand.”
Cass said there was “insufficient evidence” for her to make any firm recommendations around the routine use of puberty blockers. She told the NHS to “enrol young people being considered for hormone treatment into a formal research protocol with adequate follow-up into adulthood, with a more immediate focus on the questions regarding puberty blockers”.
Her interim report found the rise in referrals to the Gids at the Tavistock and Portman NHS foundation trust in London had resulted in overwhelmed staff and waiting lists of up to two years.
Cass said this was leaving young people “at considerable risk” of distress and deteriorating mental health. The number of referrals to the service went from 138 in 2010-11 to 2,383 in 2020-21.
Last spring, in a highly critical report on the Gids, the Care Quality Commission demanded monthly updates on waiting list numbers and actions to reduce them.
NHS England said the two new services in London and north-west England would be the “first step” in a national regional network “given the urgent requirement to stabilise current service provision for patients”.
The final number is yet to be confirmed but it is understood seven or eight services could eventually be put in place.
The London-based service will be led by Great Ormond Street hospital and Evelina London children’s hospital, with South London and Maudsley NHS foundation trust providing specialist mental health support.
A second service in the north-west will be led by Alder Hey children’s NHS foundation trust and the Royal Manchester children’s hospital, with both trusts providing specialist mental health services.
These will take over clinical responsibility for and management of all Gids patients – including those on the waiting list, the Guardian understands.
A Gids spokesperson said the service supported plans for a new model due to a rise in referrals. She said: “Over the last couple of years, our staff in Gids have worked tirelessly and under intense scrutiny in a difficult climate.”
Keira Bell, 25, who brought a high court case against the Tavistock clinic challenging its use of puberty blockers, said she was pleased with the decision to shut it.
She was prescribed puberty blockers at the age of 16 but later changed her mind over her decision to transition to male. She argued the clinic should have challenged her more over her decision to transition.
“I’m over the moon,” she told BBC Radio 4’s World at One. “Many children will be saved from going down the path that I went down.
“I went through a lot of distress as a teenager. Really I just needed some mental health support and therapy from everything that I’ve been through. There needs to be mental health support first and foremost.”
