The NHS’s only gender identity clinic for children is neither “safe nor viable” and will be replaced by regional centres.
A damning report into gender identity services, led by the Tavistock and Portman Foundation, found the pattern put children at “significant risk”.
An interim report by Dr Hilary Cass says children and young people are being subjected to “prolonged” waits to access gender dysphoria services and are not being supported during their wait.
The report says a “fundamentally different” service model is needed that can deliver timely and appropriate care for children, and recommends the NHS establish local specialist centres.
In response, NHS England said the Tavistock contract would be terminated and two specialist children’s hospital services would be created in London and the North West. It will aim to establish them by spring 2023.
The current service, run by Tavistock and Portman Hospital, has previously been accused of rushing children into hormone treatment.
According to board documents released by the hospital this week, there were more than 5,000 children waiting after referrals to its gender identity dysphoria service at the end of March 2022. The service is only accepting patients who were referred in 2018.
The waiting list for patients referred to its gender identity clinic was more than 10,000 at the end of 2021-22 and the service was accepting patients initially referred in 2017.
The trust document also shows there were 22 patient safety incidents in the last quarter of 2021-22 which involved a suicide attempt.
Gender-distressed children, Dr Cass said, were disadvantaged because local services were not equipped to see them.
She said: “It is essential that they have access to the same level of psychological and social support as any other child or young person in need, from their first encounter with the NHS and at every level in the service.”
Dr Cass’s interim report highlighted challenges at The Tavistock service, which included staff concerns about care raised in 2018.
Her full report is due to be published next year, but has so far warned that long waiting lists for children and young people to have their gender questioned is “unacceptable”.
The review said it was still unable to make 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 Cass said: “I have heard that young service users are particularly concerned that I will be proposing that services be reduced or stopped. I want to assure you that this is absolutely not the case – the opposite is true. I think more services are needed for you closer to where you live….
“I recommend that more services be provided to support you. But I have to be honest; it’s not something that can happen overnight and I can’t think of a solution that will fix the problems right away. But we have to start now.”
A report by the safety watchdog, the health safety investigation branch, warned in April that CAMHS services were being forced to “retain risk” while caring for children waiting to access specialist gender dysphoria services.
He added: “There is a lack of capacity and capability to provide proactive health risk assessment for patients waiting on the GIDS waiting list.”
The review was prompted by the death of an 18-year-old transgender man who was referred for GID at 16.
At 17, he was told he wouldn’t be seen for 22 months, but took his own life before his 19th birthday.
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