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Gender Identity Development Service

National Health Service Gender Identity Development Service
Statue of Sigmund Freud at the Tavistock Centre
Formation	1989
Purpose	Gender identity services for under 18s
Headquarters	Tavistock Centre
Location	Tavistock Centre, Swiss Cottage, London Leeds General Infirmary, Leeds
Coordinates	51°32′48″N 0°10′29″W / 51.5466°N 0.1748°W / 51.5466; -0.1748
Parent organisation	Tavistock and Portman NHS Foundation Trust
Affiliations	Tavistock Institute of Medical Psychology & NHS England
Website	gids.nhs.uk

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The NHS Gender Identity Development Service (GIDS) is a nationally-operated health clinic specialising in working with children with gender identity issues, including gender dysphoria. Although based at a Tavistock and Portman NHS Foundation Trust site, it is commissioned by NHS England and takes referrals from across the United Kingdom. It is the only gender identity clinic for people under 18 in the UK and is the subject of much controversy.

History

Pre-establishment

GIDS is a service provided by the Tavistock Clinic. Originally located at Tavistock Square in London, the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. However, it mainly focused on military psychology, including shell-shock, now termed PTSD. In 1948, with the creation of the NHS, the Tavistock Clinic launched its children’s department, which developed many works by Robertson and Bowlby on attachment theory. In 1959, it opened an adolescent department and in 1967 absorbed in the London Child Guidance Clinic. Following this, in 1989 the Tavistock Clinic established GIDS, the first and only service of its kind.

Childhood mental health services

Child and Adolescent Mental Health Services (CAMHS) provides the NHS support for children with mental health issues. However, CAMHS is organised by local government area and thus coverage varies significantly. The development of CAMHS within a four-tiered framework started in 1995. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy.

GIDS takes referrals from all mental health care professionals, especially Tier 2 and 3 CAMHS specialists. GIDS is distinct from CAMHS as is it is nationally run, not by the local authority. However, in the CAMHS framework it sits in Tier 4, as a highly specialised service.

In 1989 when the GIDS opened, "it got two referrals over the whole year."

Recent history

In 2009–10, 97 patients were referred to GIDS. By 2015–16, this had increased fourteen-fold to 1419 and in 2017–18 to 2,519. Due to reduced funding and increased referrals, the average wait time is two years from referral to first appointment.

In 2011, the GIDS started introducing the puberty blocker drug in the "early stages of puberty" because of pressure from people who felt they needed to travel to America and to Holland to obtain the drug.

In 2016, the waiting list for the clinic had increased to nine months.

In 2016, the clinic was the subject of a Channel 4 documentary programme, told from the point of view of two satisfied trans children and their families. In the same year the service, till then London based established a satellite site in Leeds.

In November 2018, the parents of patients complained in a letter to the Trust board about the alacrity at which diagnoses were rendered, leaving them unable to intervene in these "life-altering decisions". This led to the commissioning of an internal report by Dr David Bell, which concluded in February 2019 that the service was “not fit for purpose”, as children were being prescribed experimental drugs "after a few sessions and without proper investigation of their cases... under pressure from transgender rights groups". Bell urged the suspension of "all experimental hormone treatment for children who wished to change gender until there was better evidence of the outcomes." Dr Marcus Evans, a member of the Tavistock and Portman NHS Foundation Trust governance board, resigned that week after a 35-year association with the T&P. He accused its management of having an "overvalued belief in" the expertise of GIDS, "which is used to dismiss challenge and examination."

Subsequently to the Bell report it was revealed that 35 psychologists had resigned since 2016, including six psychologists who claimed there was “over-diagnosis” of gender dysphoria and a push for early medical intervention, because "psychologists fear being branded transphobic."

In February 2019, it was revealed that the National Institute for Health Research (NIHR) had announced a £1.3 million grant for a study following young people referred to GIDS, to compare mental and physical health outcomes for children referred. The study was to compare the effectiveness of different interventions, including psychological, endocrinological, pharmaceutical and alternative interventions.

In July 2019, the Tavistock Centre was flooded which temporarily affected the IT servers at the clinic.

In October 2019, a lawsuit was launched against GIDS by a mother of a patient at GIDS and Sue Evans, a nurse who formerly worked there. Later, Evans passed their role as complainant to Keira Bell, a previous service user. In December 2020 following the High Court judgement, GIDS suspended all new referrals to endocrinology. The Court granted a stay on further implementation of the judgement until 22 December 2020 or until appeals are exhausted.

In December 2020 Dr Bell, a former governor of the Trust who was elected by the medical staff, and who had produced in February 2019 a damning report on the methods of the GIDS, reported that he now faced "disciplinary action" from the Trust.

Leadership

Dr Polly Carmichael has led the GIDS since at least 2016. At the time, she was treating children as young as three. Carmichael has expressed fear of "a danger where you get into a place where you're afraid to say anything for fear of being accused of being transphobic... I think it would be naïve to say that gender is not political, because it is... Gender and trans has been taken up in the political arena... Only last year we had the Women and Equalities Committee's transgender equality inquiry in Parliament."

Services

Services provided include:

• Assessments, to assess primary medical aims and necessary support;
• Gender development support, including access to therapy, tailored support and therapy groups;
• Physical intervention, including endocrinological intervention such as puberty blockers and sex hormones;
• Mental health support, usually working alongside CAMHS;
• Ongoing support post social or medical transition and referral to adult gender identity services.

No surgical transition options are available through GIDS.

People referred to GIDS may also contribute to NIHR studies into gender dysphoria in children.

Referrals

In the financial year 2018–19, 31 referrals were made for children aged 5 or under. 30 referrals were made for adults over the age of 18. In 2018–19, there was a year-on-year increase of 6%, a relative plateau compared to previous year-on-year increases. Similarly, there was only a 0.1% increase in referrals between the 18–19 and 19–20 financial years.

Children who present may identify with a number of different labels, including non-binary, transgender, genderqueer, questioning or otherwise as simply dysphoric or gender non-conforming. GIDS say that the way children identify is changing, which may be due to cultural and societal shifts.

Controversy

As the only gender identity clinic for children in the UK, the service has been the subject of much controversy related to the broader topic of gender dysphoria and transitioning in childhood.

High resignation rate

A 2019 Sky News report found that 35 psychologists resigned between 2016 and 2019. Six psychologists who resigned raised concerns about the over-diagnosis and medicalisation of young people experiencing gender identity difficulties. In February 2019, Tavistock trust member Marcus Evans resigned, citing similar concerns. In July 2019, Kirsty Entwistle wrote a public letter about the GIDS service, saying professionals were often labelled “transphobic” if they raised doubts. Clinicians have stated that concerns over children's welfare were "shut down".

Bell Report

Following a letter to the board at Tavistock, an internal report was commissioned to look at the functioning of GIDS. Dr David Bell authored the report which found that the service was “not fit for purpose”. It considered that the service could result in “damaging consequences” to children’s lives and failed to fully consider a child’s mental health background. However, it did not identify any “immediate” issues with regards to safety and in 2018 the CQC rated the effectiveness of the Trust as “outstanding”.

Conversely, there is a long wait time for a first appointment at GIDS, averaging at two years as of January 2020. GIDS blame high referral numbers and low staff numbers for this wait time.

Leeds lawsuit

In October 2019, a legal complaint was lodged against GIDS at its satellite site in Leeds. The suit was brought by “Mrs. A”, a mother of a 15-year-old patient with autism, and Sue Evans, a former nurse at the Leeds GIDS satellite site. It alleges that advice around hormone therapy was “potentially misleading” and that true informed consent could not be given under such circumstances. The suit describes hormone therapy as “experimental” and states that there is “robust evidence” to show long-lasting medical effects of hormone therapy. Some time after January 2020, Evans passed on her role as complainant to Keira Bell "who was prescribed puberty blockers by GIDS when she was 16. She had a double mastectomy aged 20, and now regrets transitioning, which has left her with 'no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered'. She may well be infertile as a side effect of the drugs." In a judgment delivered on 1 December 2020, the judges said that it was 'highly unlikely that a child aged 13 or less would be competent to give consent to the administration of puberty blockers', and that it was 'doubtful that 14 or 15 year olds could understand the long-term risks and consequences' of this form of treatment. Where the young person is 16 or over, '...we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment.' Immediately following the High Court judgement, GIDS suspended all new referrals to endocrinology. The Court granted a stay on further implementation of the judgement until 22 December 2020 or until the appeal process was complete, whichever was later. Amnesty International and Liberty issued a joint statement emphasising their concern on "the wider implications this will have on the rights of children and young people of all genders, particularly on consent and bodily autonomy." Consortium issued a statement stating that the ruling "could have a potentially devastating impact on young people seeking access to medical services." Leave to appeal against the decision of the High Court was granted in January 2021.

Royal College of General Practitioners (RCGP) position

The RCGP report on transgender healthcare in the UK found several flaws in the NHS approach. It called for a "whole system" change, including addressing waiting times and the lack of research around gender dysphoria in children. The report noted the expansion of gender identity services into all four UK nations and "welcomes the forthcoming postgraduate diploma in Gender Identity Healthcare Practice." The report also noted that "in England, for example, GICs have seen a 240% overall increase in referrals over five years, with referrals to the Tavistock and Portman clinic alone increasing 8.43% between March 2018-19."

See also

• Transitioning (transgender)
• Transgender health care
• Transgender rights in the United Kingdom
• Childhood gender nonconformity
• Gender dysphoria in children
• Transgender youth

References

1. Dicks, H.V., (1970). 50 Years of the Tavistock Clinic. London: Routledge and Kegan Paul. Reissued by Routledge, 2014, ISBN 978 1 138 82194 1
2. "The London Child Guidance Clinic in Islington". Lost Hospitals of London. Retrieved 10 January 2020.
3. "Gender Identity Development Service (GIDS)". tavistockandportman.nhs.uk. Retrieved 13 January 2020.
4. ^ Stevens, Jenny (16 November 2016). "Meet the Doctor Who Runs the Only Clinic for Trans Children in the UK". Vice Media Group.
5. "The Times view on the Tavistock clinic and hormone-blocking drugs for the young: Informed Consent". 12 October 2019. ISSN 0140-0460. Retrieved 13 January 2020.
6. ^ "Referrals to the Gender Identity Development Service (GIDS) level off in 2018-19". tavistockandportman.nhs.uk. Retrieved 13 January 2020.
7. https://adc.bmj.com/content/103/7/631
8. ^ Doward, Jamie (3 November 2018). "Gender identity clinic accused of fast-tracking young adults". The Observer. ISSN 0029-7712. Retrieved 13 January 2020.
9. ^ Bannerman, Lucy (5 December 2020). "David Bell: Tavistock gender clinic whistleblower faces the sack". Times Newspapers Limited.
10. ^ Doward, Jamie (23 February 2019). "Governor of Tavistock Foundation quits over damning report into gender identity clinic". The Observer. ISSN 0029-7712. Retrieved 13 January 2020.
11. ^ Donnelly, Laura (12 December 2019). "Children's transgender clinic hit by 35 resignations in three years as psychologists warn of gender dysphoria 'over-diagnoses'". The Telegraph. ISSN 0307-1235. Retrieved 13 January 2020.
12. ^ "NHS 'over-diagnosing' children having transgender treatment, former staff warn". Sky News. 12 December 2019.
13. "Flood at the Tavistock Centre – Sunday 28 July 2019 | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
14. ^ "UK mom sues Tavistock children's clinic over 'misleading' & 'experimental' gender change treatments". RT International. Retrieved 13 January 2020.
15. ^ Social Affairs Editor, Greg Hurst (12 October 2019). "Mother sues Tavistock child gender clinic over treatments". The Times. ISSN 0140-0460. Retrieved 13 January 2020. {{cite news}}: |last= has generic name (help)
16. ^ "Update on the Judicial Review, Tuesday 1 December 2020". tavistockandportman.nhs.uk. Retrieved 8 December 2020.
17. ^ "About us | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
18. "Tavistock and Portman NHS Foundation Trust". www.cqc.org.uk. Retrieved 13 January 2020.
19. ^ "Gender Identity Development Service referrals in 2019-20 same as 2018-19". tavistockandportman.nhs.uk. Retrieved 26 February 2021.
20. ^ "Current debates | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
21. Entwistle, Kirsty (18 July 2019). "An open letter to Dr Polly Carmichael from a former GIDS clinician". Medium. Retrieved 13 January 2020.
22. Barnes, Hannah; Cohen, Deborah (19 June 2020). "NHS child gender clinic: Staff concerns 'shut down'". BBC Newsnight. BBC News. Retrieved 19 June 2020.
23. "Tavistock and Portman NHS Foundation Trust". www.cqc.org.uk. Retrieved 13 January 2020.
24. "About us | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
25. Bartosch, Josephine (5 December 2020). "Why I was right to blow the whistle on the Tavistock Clinic over puberty blockers". Telegraph Media Group Limited.
26. "Puberty blockers: Under-16s unlikely to be able to give informed consent 1 December 2020". BBC. BBC.
27. "Amnesty International UK and Liberty joint statement on puberty blockers". www.amnesty.org.uk. Retrieved 8 December 2020.
28. "Consortium Statement on Bell v Tavistock Outcome". www.consortium.lgbt. Retrieved 8 December 2020.
29. Topping, Alexandra. "HIgh court grants leave to appeal to UK gender identity service 19 January 2021". Guardian. Guardian. Retrieved 20 January 2021.
30. ^ "RCGP calls for whole-system approach to improving NHS care for trans patients". www.rcgp.org.uk. 25 June 2019.

• Transgender and medicine
• NHS trusts
• National Health Service (England)