NHS England’s new gender identity services could be a “regression” of what was offered at the Tavistock, a leading expert in the field has warned.
Next month, Great Ormond Street in London and Alder Hey children’s hospital in Liverpool will be the new homes of such services in England and Wales.
The sites will replace the Gender Identity Development Service (GIDS), which is run by the Tavistock and Portman NHS foundation trust, after it closes at the end of March.
They are the first of what NHS England hopes will eventually be several regional gender identity centres across the country, but Dr Aidan Kelly, a clinical psychologist who worked at GIDS from 2016 to 2021, is sceptical of what this could look like in practice.
“The problem I have is not the proposed plan,” he tells GAY TIMES. “It’s the reality.”
“The pressures and strains are going to be the same”
It was announced in 2022 that GIDS would be closing after more than three decades as a result of criticism from an independent review and being deemed “inadequate” by inspectors who visited in late 2020.
Dr Hilary Cass, the paediatrician who is leading the aforementioned review into gender identity services for trans youth, previously said that a “fundamentally different” approach was needed as the current provider model “is not a safe or viable long-term option”.
She suggested that the regional centres replace GIDS in order to help cut waiting times and be more accessible to young people across the entire country.
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At present, if no changes were made to service provisions or the size of waiting lists, it would take 10 years to clear the backlog of people waiting for first appointments in gender care on the NHS, according to BBC analysis.
Despite the new hubs being launched to tackle issues like this, Kelly is concerned that this will prove difficult because “the pressures and strains are going to be the same”.
“In a way, what happened at GIDS and the Tavistock, I don’t believe was particular to GIDS or the Tavistock, it just happened to be the only one institution in England and Wales that was offering this,” he adds.
“And so the difficulties became located in that place because it was the only institution offering it, but I don’t see how what’s going to happen in the London or the northern hub, and in any other potential hubs, will be any different.”
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Kelly says that media discourse around GIDS – and trans issues more generally – has become “highly politicised” in recent years, which he feels any new gender identity service needs to be prepared for.
“By shutting down and scapegoating the GIDS clinic, you’ve also sent out a message to a potential candidate [and] potential employees that actually, you could be hung out to dry here a little bit and scapegoated if NHS England or whoever else changes their mind,” he says.
“It doesn’t send out a very reassuring message when the NHS as a general institution is struggling to recruit and fill vacancies.
“You’ve got to a position where potential staff can be relatively picky in terms of what jobs they might take and I don’t see why gender would be a particularly appealing area to work in for a potential candidate at the moment.”
The opening of the new hubs has been delayed by more than a year
The new gender services have already faced delays in getting open due to not being ready, with original plans to have GIDS closed by the spring of 2023 pushed back by a year.
There have reportedly been difficulties in recruiting staff, with The Guardian reporting that the team were failing to agree on things as basic as how to define terms like ‘gender’.
NHS England’s new clinics will be led by doctors with expertise in gender, paediatric medicine, autism and mental health, among other things, but Kelly has concerns that the current staff at GIDS will not be transferred across to the new facilities.
“You need to be able to learn from [GIDS] and so having that knowledge base kind of carry on would make sense to me, but I think that is going to be a challenge they’re going to face,” he explains.
“My concern would be that they might repeat the same mistakes, I suppose, because they haven’t got that learning.”
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Kelly continues: “The service that’s going to be available to young people doesn’t appear to be a progression, but rather a regression in terms of what’s been offered.”
When approached for comment by GAY TIMES, NHS England did not confirm or deny whether or not GIDS staff will be involved in its new gender identity services.
In an email response, a spokesperson said: “In line with the Cass Review, NHS England took the decision to close the Tavistock and set up a fundamentally different and improved approach to children and young people’s gender services.
“This transition is a complex piece of work which is why we have ensured every family has received a letter informing them of the changes, patients will see continuity of care when the new services come on line from April, and all patients waiting will be offered a local mental health assessment if they want it, with extra national resource provided to ensure the best possible support.”
“It feels a bit like we’re going backwards”
Kelly, who is now the Clinical Director of Gender Plus, an independent gender service, explains that he and his team have written to NHS England and are due to meet with them next month.
He says the team is always “open to” assisting it where they can, as the “reality” is that their work is likely going to overlap which needs to be managed “in a safe, clinical way”.
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“It feels a bit like we’re going backwards instead of forward in terms of building capacity and being able to see more people,” he says of the new services.
“And so my concern is actually that the service that’s going to be available to young people doesn’t appear to be a progression, but rather a regression, I suppose, in terms of what’s been offered.”
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