After reporters expressed fears about the care they provide, older transgender clinics in England are facing a Cass-style investigation into how they treat people.
Following past and present team sharing concerns personally during a previous research, NHS England has announced that it will be setting up an evaluation of how the seven professional services operate and provide care.
As a first step, NHS England may give “external quality improvement specialists” into each of the hospitals to gather information about how they care for patients, to help guide the inquiry way.
Following Dr. Hilary Cass’ monument review, which was published on Wednesday and was a former head of the Royal College of Paediatrics and Child Health, which suggested radical changes to the way the health services treats under-18s who are uncertain about their gender identity, the decision was made.
NHS England responded to Cass’ report by sending a letter to the seven trusts that host adult gender dysphoria clinics (GDCs) on Tuesday, stating that “we will be launching a review into the operation and delivery of the adult GDCs, along with the planned review of the adult gender dysphoria service specification.”
According to sources from the NHS, the review may be similar to Cass’s investigation. It was brought on by a lack of reliable data on pressing problems involving the treatment of children and young people who are unsure of their gender identity, such as the safety and efficacy of cross-sex hormones, which are masculinizing or feminizing.
“It will be physical, rather than done in-home. It will be led by one outside. It will be very similar to what Cass did with son’s companies, but this time it will be looking at mature service,” a source said. It could “conceivably” be a senior doctor like Cass.
The letter stated that the investigation was necessary because of “concerns raised by current and former personnel members working in the adult gender clinics about medical practice, particularly in regards to individuals with intricate co-presentations and untreated conditions.”
According to John Stewart and Prof. James Palmer, NHS England’s regional director and health director, both, there is “an increasing incidence of individuals seeking detransition” following past gender affirming interventions and the absence of a steady, defined medical approach for them.
Mermaids, a generosity supporting transgender, nonlinear and sex-questioning kids, welcomed that Cass’s review “recognises the present system is failing trans youth”.
However, a spokesperson continued, “We are concerned that some of the language in the review could be used to support further barriers to accessing treatment for some trans young people in the same way that the interim statement was.”
Additionally, NHS England intends to compel adult gender dysphoria clinics to provide data that they had previously requested from University of York researchers to help them come up with best practice recommendations for how the NHS does support for disadvantaged young people.
It may describe the health benefits of the 9,000 individuals who were cared for by the Tavistock and Portman NHS cognitive health trust’s gender identity development assistance as minors.
Six of the seven trusts refused to cooperate, making Cass complain in her report that an important research project had been “thwarted” by NHS secrecy.
Wes Streeting, the shadow health secretary, said he was “pretty angry” to learn about the blocking tactics. “You won’t get away with it under a Labour government,” he said.
NHS England made it clear to the trusts in the same letter that if they do not provide the details, they will use “compelling instructions” to compel them to do so.
Concerns raised by whistleblowers in 2018 at the Tavistock and Portman NHS Foundation Trust Clinic’s gender identity development service led NHS England to choose to commission the independent Cass review into the services provided to children and young people with gender-related distress.
In 2018, Dr. David Bell, a senior psychiatrist and Tavistock staff governor, presented an internal report to the board with testimony from 10 clinicians. He warned that the clinic was neglecting children and that staff should suspend hormone therapy for children until better evidence for the results was available.
Cass claimed to the Guardian that the “thwarting” of the research project was “ideologically driven and coordinated.” All but one of the adult GDCs objected to the University of York, she said, and they also refused to allow the study’s initial opt-out stage.
The Devon Partnership mental health trust was the only one of the seven to provide the information to York researchers. It was “deeply troubling that attempts to gather evidence for the Cass review have been deliberately blocked,” said Kate Barker, the CEO of the LGB Alliance.
Mermaids said it welcomed “calls for more high-quality, transparent research which supports trans children and young people to receive timely, holistic, supportive and personalised care”.
The six trusts’ refusal to cooperate was cited for a number of reasons, including resource impacts, Cass wrote, and ethical considerations, despite Cass claiming that NHS England would have covered appropriate costs if appropriate costs had been paid for by NHS England.
There was no compelling reason for it. So I can only draw the conclusion that it was because they didn’t think it was the best way to try to pin down this information, she told the Guardian. They were putting up reasons that didn’t that just didn’t hold water.
“Clearly, the trans community is fearful, rightly so, about their rights and about their healthcare. They’ve had a very bad deal in healthcare. I get the impression that both they and the service providers will be concerned about anything that might come into question. However, I believe we must distinguish between the rights of younger people who are still on a developmental trajectory and older adults, on whom we have more information and who are at a stable point in their lives.
Robbie de Santos, director of campaigns and human rights at Stonewall, an LGBT rights charity, said: “Gender healthcare for adults in the UK is, simply put, not fit for purpose. Many trans adults are being forced to go private at great personal expense to avoid waiting lists for more than a decade. A review that addresses this unacceptable state of affairs and introduces capacity into the system is welcomed.
