The Times- Sajid Javid inquiry into gender treatment for children

 

Sajid Javid inquiry into gender treatment for children

Health secretary compares political fears over trans issue to silence during Rotherham scandal

A review into NHS gender identity services for children found they were being affected by a lack of expert agreement about the nature of problems, a “lottery” of care and long waiting lists

BARBARA COOK/ALAMY

Chris Smyth

, Whitehall Editor

Friday April 22 2022, 10.15pm, The Times

Vulnerable children are wrongly being given gender hormone treatment by the NHS, Sajid Javid believes, as he prepares to launch an urgent inquiry.

The health secretary thinks the system is “failing children” and is planning an overhaul of how health service staff deal with under-18s who question their gender identity.

Javid is understood to have likened political sensitivities over gender dysphoria to the fears of racism in Rotherham over grooming gangs.

Sajid Javid thinks the system is “failing children”

REUTERS

Clinics in London, Leeds and Bristol run by the Tavistock & Portman NHS Foundation Trust are England’s only specialist services for children and young people who identify as transgender. Critics have accused the trust of rushing children into life-altering treatment and being too willing to give puberty blockers to young teenagers.

However, the Court of Appeal last year upheld the right of the trust to give puberty blockers to under-16s if they are deemed capable of consenting.

Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, has been leading a review into NHS gender identity services for children. In interim findings last month, she said children were being affected by a lack of expert agreement about the nature of gender identity problems, a “lottery” of care and long waiting lists.Javid is said to be particularly alarmed by her finding that some non-specialist staff felt “under pressure to adopt an unquestioning affirmative approach” to transitioning and that other mental health issues were “overshadowed” when gender was raised.

“This has been a growing issue for years and it’s clear we’re not taking this seriously enough,” an ally of the health secretary said. “If you look at Hilary Cass’s interim report, the findings are deeply concerning and it’s clear from that report that we’re failing children.”

The ally said services should have a holistic view of what might be causing problems for that child: a mental health issue, bullying or sexual abuse.

“That overly affirmative approach where people just accept what a child says, almost automatically, and then start talking about things like puberty blockers — that’s not in the interest of the child at all,” the ally said.

The Tavistock & Portman NHS Foundation Trust sees 2,500 children a year — 200 of whom access hormones. Referrals have increased 50-fold in the past decade, with far more female-born children now coming forward in a reversal of previous trends.

While the trust accepts the need for changes, it insists that doctors already take children’s wider social and mental health issues into account. Javid is understood to be preparing legal changes that would give Cass access to an NHS database of children treated by the service to see how many later regretted taking puberty-blockers and less reversible cross-sex hormones.

“The review has already come across a number of adults that were given these life-changing drugs as children and are now saying, ‘Why did you do that? Because that wasn’t my problem. I was sexually abused. I was being bullied,’ ” a health source said. “We need to find out how many of these people there are.”

The inquiry will form part of Cass’s final report but Javid is understood to want to begin making the NHS change its approach immediately. This week he told MPs: “The NHS services in this area are . . . bordering on ideological.”

A spokesman for Tavistock & Portman NHS Foundation Trust said: “Being respectful of someone’s identity does not preclude exploration. We agree that support should be holistic, based on the best available evidence, and that no assumptions should be made about the right outcome for any given young person.”

A senior government source said Javid believes “far too many public figures have been avoiding [gender issues] for too long” but argued: “There is a militant lobby that doesn’t want a debate.”

His allies say the “toxic” discussion on gender issues makes it harder to raise questions of child welfare.

Some around him say the question has been likened to concerns he raised while home secretary about the failure to tackle child exploitation by gangs of predominantly British-Pakistani men in Rotherham. The senior government source said: “There is the same theme of not being afraid to tackle issues that others might prefer not to talk about.”

Why is gender identity in children such an issue now?
As well as wider social debates about the nature of gender and its relation to biology, there has been a huge increase in children and teenagers being referred for NHS treatment for gender identity issues. In 2009 only 50 were referred but last year there were 2,500. Twice as many coming forward are female-born children, in a reversal of the pattern a decade ago. The reasons for this are not clear.

Who treats these children?
GPs largely refer children and teenagers to specialist services which in England and Wales are all run by the Gender Identity Development Service (GIDS) at the Tavistock & Portman NHS Foundation Trust. This is the only service that refers for hormone treatment but the waiting list has grown to 4,600 and there is widespread acceptance that reform is needed.

What is hormone treatment, what does it do and is it safe?

Under 10 per cent of the children referred to the GIDS service are sent on for hormone treatment as teenagers. Such treatment often involves first puberty blockers to delay the development of adult sexual characteristics.

Cross-sex hormones are later given to encourage masculine or feminise characteristics. These can affect fertility although evidence on long-term effects is lacking. Almost all children who start on puberty blockers go on to cross-sex hormones.

What are the concerns?
An interim review by Hilary Cass found that services had developed without clear rules, and there was a “clinician lottery” with widely varying approaches to treatment. She found there was “a lack of agreement, and in many instances a lack of open discussion” about whether unhappiness with gender in adolescence is permanent or temporary. She suggested stricter requirements over psychological interventions for other mental health needs before hormone treatment. However, she also found that long waiting lists left children unhappy and meant some are then impatient with further assessment.

What is Sajid Javid most worried about?
He is alarmed Cass’s finding of “diagnostic overshadowing”, in which other serious problems are overlooked as soon as gender identity is mentioned. He believes this contributes to an “overly affirmative approach” which pushes children towards transition.

The GIDS service insists it takes a broad overview of children’s needs, arguing that taking their sense of identity seriously does not exclude other options, with Cass herself saying that “affirmative” and “explorative” approaches were not “mutually exclusive”.

Do children regret having hormone treatment later?
The GIDS service insists this is “extraordinarily rare”, despite high profile examples such as Keira Bell, who has taken the trust to court.

Javid is concerned that there is no good data and that NHS confidentiality rules prevent researchers from systematically following up those who have been prescribed hormones. He is planning a change in the law to allow a proper study of the question.

Is this politically driven?

Although Javid has been among the most outspoken ministers on gender issues, his allies insist that the “toxic” debate on gender makes it harder to discuss clinical questions calmly and there is a need to “lower the temperature”. Both he, the Tavistock and campaign groups on both sides have welcomed the Cass review, which is due to make detailed recommendations later this year.