England’s National Health Service (NHS) is closing the doors of the country’s only trans health clinic for youth, in the wake of a critical independent review—as well as years of controversy.
The NHS announced last week that it would be closing the Tavistock and Portman NHS foundation trust’s Gender and Identity Development Service (GIDS) clinic, which has provided gender-affirming care to youth for over 30 years. In recent years, patients and families have raised concerns about the deteriorating quality of the clinic’s services—leading investigators to deem it “inadequate” in an NHS-commissioned report released last year.
The report notes that the clinic has been unable to keep up with growing demand for its services, resulting in staggering wait times. More than a quarter of the clinic’s patients were waiting over two years to receive care, and two-thirds were waiting over a year—which the report noted put already vulnerable populations at elevated risk for self harm. Dr. Hilary Cass, who led the independent review, noted in a subsequent March 2022 report that it had become “increasingly clear that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand.”
Criticisms of the clinic came from both pro and anti-trans camps in the wake of a December 2020 case brought by Keira Bell against the Tavistock and Portman NHS Foundation Trust. Bell saw clinicians at Tavistock to start puberty blockers at age 16, but later detransitioned and said that she regretted the treatment. A court initially ruled in Bell’s favour, preventing doctors from prescribing puberty-blocking drugs to patients under 16 without a judge’s approval—despite the fact that studies show the drugs have overwhelmingly positive effects on patients’ mental health. Bell v. Tavistock was ultimately overturned by an appeals court in September of last year.
In the wake of the initial ruling, the Tavistock clinic became a lightning rod for anti-trans sentiment in the U.K., with some accusing doctors of rushing patients into treatments, while trans advocates criticized its long wait times. Cass’s report found “insufficient evidence” to make any recommendations around the clinic’s use of puberty blockers.
After its closure next year, the clinic will be replaced by regional centres that will “ensure the holistic needs” of patients remain met. The change comes at the recommendation of Cass, who says that the regional centres should be led by experienced pediatric care providers who can “ensure a focus on child health and development, with strong links to mental health services.”
A senior NHS source told the Guardian that there will be no immediate changes to service, and patients currently being seen by the clinic, as well as those on the waiting list, will be transferred to a new provider by spring 2023. While the final number of regional clinics isn’t set in stone, seven or eight are expected, with the first two located in London and northwest England.
LGBTQ+ organizations Stonewall U.K. and Mermaids both welcomed the changes with some trepidation, per the Daily Beast. On Twitter, Mermaids noted that the organization has been “calling for drastic improvements for many years.” They added, “We welcome the Cass recommendations and are cautiously optimistic that we might finally see positive change and investment in the current system, after years of pain and anguish, which has caused untold damage to the health and well-being of trans young people and their families.”
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