The British health service, the NHS, has ordered that the Tavistock transgender clinic for children be shut down after a review found that it is “not safe’.
The clinic, which had become the subject of considerable controversy after claims that it was “unquestioning ” where children sought to change gender, was found “not a safe or viable long-term option” by an independent review earlier this year.
The review, led by Dr Hilary Cass, a consultant paediatrician, warned that medics in the Tavistock clinic felt “under pressure to adopt an unquestioning affirmative approach” to gender identity, instead of adopting a process of clinic assessment with young people who might have expressed some form of gender dysphoria.
In 2020, the clinic was rated “inadequate” – with the UK’s health watchdog, the Care Quality Commission, giving it the lowest rating possible.
The Inspectors said that “many of the young people waiting for or receiving a service were very vulnerable and at risk of self-harm. Despite this staff often did not assess the risks presented by young people and their families.”
In a high-profile case, a former patient, Keira Bell, brought Tavistock to the High Court saying that should have challenged her when she was a child over her desire to undergo a transition from female to male. She said she was prescribed puberty-blocking drugs at the age of 15 to stop the process of developing female sexual characteristics. After a period, her treatment led to her taking cross-sex hormones to promote the development of male characteristics, and she then underwent breast removal surgery at the age of 20.
At the time, Tavistock defended its actions, saying that children were capable of decision making, but they were criticised by another claimant in the case, who was the mother of an unnamed teenage autistic girl waiting for treatment.
“A child experiencing gender distress needs time and support – not to be set on a medical pathway they may later regret,” said the claimant, identified in news reports only as Mrs. A.
Tavistock came under fire for making decisions to give children as young as 10 puberty blockers. The NHS have said they will follow Dr Cass’s recommendation that they carry out “rapid” research on the effect of puberty blockers on young people, after she noted that there is currently “insufficient evidence” on their impact.
Dr Cass’s report said there was a lack of understanding in Tavistock about why the type of patients the clinic was seeing was changing, with more female to male patients and more autistic children. She also highlighted what she saw as inconclusive evidence to back some of the clinical decisions made in the sex-change centre.
The NHS now says the services will operate in eight regional centres, and that recommendations from the Cass review which state that “staff should maintain a broad clinical perspective in order to embed the care of children and young people with gender uncertainty within a broader child and adolescent health context’, will be followed.
“The ongoing work of Dr Cass’ review, alongside our experience in establishing the Early Adopter services, will help shape the development of the new model of care, national standards and a new national service specification against which regional services can be commissioned,” an NHS England spokesperson said.
“We will engage and consult fully on this service specification in due course.”
Tavistock had been assessing Irish child and adolescent patients for at least a decade, with a team from the English clinic visiting Crumlin hospital on a monthly basis until recently.