A damning report into gender identity services, run by The Tavistock and Portman Foundation Trust, found the model puts children at “significant risk”. An interim report by Dr Hilary Cass, said children and young people are subject to “long” waits to access gender dysphoria services and are not receiving support while they wait. The report said a “fundamentally different” service model is needed that can provide timely and appropriate care for children and recommended the creation of local specialist NHS centres. In response, NHS England said the contract with Tavistock would end and two services would be created from specialist children’s hospitals in London and the North West. It will aim to have them in place by spring 2023. The current service, run by The Tavistock and Portman Hospital, has previously been accused of pushing children into hormone therapy. According to board documents released by the hospital this week, more than 5,000 children were waiting after referral to the gender identity disorder service at the end of March 2022. The service is only seeing patients referred in 2018. The waiting list for patients referred to the gender identity clinic was over 10,000 at the end of 2021-2022 and the service was seeing patients initially referred in 2017. The trust document also shows it had 22 patient safety incidents in the last quarter of 2021-2022, which included a suicide attempt. Children with gender dysphoria, Dr Cash said, are at a disadvantage because local services are not equipped to see them. He said: “It is important that they can access the same level of psychological and social support as any other child or young person at risk, from their first encounter with the NHS and at every level within the service.” Dr Cass’s interim report highlighted the challenges in The Tavistock’s service, which included staff concerns about care raised in 2018. Its full report is due to be published next year, but so far it has warned that long waiting lists for gender inquiries for children and young people are “unacceptable”. The review said it was not yet able to provide recommendations about the use of puberty blockers and feminizing or masculinizing hormones because of gaps in the evidence. In a letter to children affected by the changes, Dr Cash said: “I have heard that young service users are particularly concerned that I will be proposing to reduce or stop services. I want to assure you that this is absolutely not the case – the opposite is true. I think they need more services for you closer to where you live… “I advise that more services are available to support you. But I have to be honest. this is not something that can happen overnight and I can’t find a solution that will fix the problems immediately. However, we must start now.” A report by safety watchdog the Healthcare Safety Investigation Branch in April warned that CAMHS services were forced to “run the risk” while caring for children waiting to access specialist gender dysphoria services. He added: “There is a lack of capacity and capability to ensure proactive health risk assessment of patients waiting on the GIDS waiting list.” The review was prompted by the death of an 18-year-old transgender man who had been referred to GIDs at the age of 16. At 17 he was told he wouldn’t be seen for 22 months, but he killed himself before his 19th birthday.
