Misplaced Pages

This is an old revision of this page, as edited by ArcMachaon (talk | contribs) at 00:44, 26 February 2021 (→Referrals: more updates for 19/20 year). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

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

Part of a series on
LGBTQ rights in the United Kingdom
By location
United Kingdom Scotland Northern Ireland
Crown dependencies Guernsey Jersey Isle of Man
Overseas Territories Anguilla Akrotiri and Dhekelia Bermuda British Virgin Islands Cayman Islands Falkland Islands Gibraltar Montserrat Pitcairn Islands Saint Helena, Ascension and Tristan da Cunha Turks and Caicos Islands
Same-sex marriage by territory United Kingdom Scotland Northern Ireland Guernsey Jersey Isle of Man Akrotiri and Dhekelia Bermuda British Antarctic Territory British Indian Ocean Territory Cayman Islands Falkland Islands Gibraltar Pitcairn Islands Saint Helena, Ascension and Tristan da Cunha South Georgia and the South Sandwich Islands
Policy aspects
Sexual orientation Adoption Age of consent Blood donation Christian nation Civil partnership History of violence HIV/AIDS Military policy Same-sex marriage
Gender identity, sex and intersex 21st-century anti-trans movement Transgender rights Intersex rights NHS Gender Identity Development Service Gender Recognition Panel
Legislation
Criminality Buggery Act 1533 Offences Against the Person Act 1828 Offences Against the Person Act 1861 Labouchere Amendment Wolfenden report Sexual Offences Act 1967 Criminal Justice (Scotland) Act 1980 Homosexual Offences Order 1982 Section 28 Criminal Justice and Public Order Act 1994 Sexual Offences (Amendment) Act 2000 Sexual Offences Act 2003 Policing and Crime Act 2017 Alan Turing law Merchant Shipping (Homosexual Conduct) Act 2017 Historical Sexual Offences (Pardons and Disregards) (Scotland) Act 2018
Protection and recognition Public Order Act 1986 Sex Discrimination (Gender Reassignment) Regulations 1999 Adoption and Children Act 2002 Employment Equality (Sexual Orientation) Regulations 2003 Civil Partnership Act 2004 Gender Recognition Act 2004 Equality Act 2006 Equality Act (Sexual Orientation) Regulations 2007 Criminal Justice and Immigration Act 2008 Human Fertilisation and Embryology Act 2008 Equality Act 2010 Marriage (Same Sex Couples) Act 2013 Marriage and Civil Partnership (Scotland) Act 2014 Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019 Northern Ireland (Executive Formation etc) Act 2019
Litigation Corbett v Corbett (1969) X v United Kingdom (1978) Dudgeon v United Kingdom (1981) R v Brown (1993) Sutherland v United Kingdom (1994) Smith and Grady v United Kingdom (1999) Goodwin & I v United Kingdom (2002) HJ and HT v Home Secretary (2010) National AIDS Trust v NHS Service Commissioning Board (2016) Bell v Tavistock (2021) AB v CD and others (2021)
Culture
By city Brighton Cardiff London Liverpool Leeds Manchester
Gay villages Birmingham Gay Village The Calls Canal Street (Manchester) Old Compton Street Pride Quarter, Liverpool Vauxhall
Gay male Polari Saunas Cruising
Organisations
LGBT advocacy and support Stonewall Hall–Carpenter Archives Black Gay Men's Advisory Group Akt Naz and Matt Foundation FFLAG LGBT Foundation LGBT Network Outright Scotland Switchboard (UK) NUS LGBT LGBT+ Liberal Democrats LGBT+ Conservatives LGBT+ Labour Labour Campaign for Trans Rights Mermaids Press for Change The Gender Trust
Pride events BiCon (UK) Big Gay Out Birmingham Pride Bourne Free Brighton Pride Bristol Pride Doncaster Pride GFest – gayWise LGBT Arts Festival Glasgay! Festival Homotopia (Liverpool) Leeds Pride Leicester Pride LGBT History Month BFI Flare: London LGBT Film Festival Manchester Pride Mr Gay UK Mr Gay Wales Northern Pride Nottinghamshire Pride Pride Cymru Pride Glasgow Pride in Hull Pride in Liverpool Pride in London Pride Scotia Reading Pride Swansea Pride Worthing Pride
Former groups OutRage! Campaign for Homosexual Equality Homosexual Law Reform Society Gay Liberation Front Gay Rights Working Party Order of Chaeronea
History
Topics Timeline List of politicians First LGBT officeholders Violence against LGBT people HIV/AIDS crisis Death penalty
Timeline 342 MSM activity made illegal 1533 Death penalty introduced for MSM activity 1543 Buggery Act extended to Wales 1828 Offences Against the Person Act 1828 1835 James Pratt and John Smith executed 1861 Death penalty for buggery abolished 1885 Labouchere Amendment introduced 1889 Cleveland Street scandal 1895 Oscar Wilde found guilty of gross indecency 1912 The Cave of the Golden Calf opens 1921 Plans to make lesbian activity illegal defeated 1936 Mark Weston transitions 1952 John Nott-Bower begins crackdown 1954 Pitt-Rivers, Montagu, Wildeblood imprisoned 1954 Alan Turing commits suicide 1957 Wolfenden report released 1967 MSM activity made legal (England & Wales) 1972 First British Gay Pride Rally 1976 Jeremy Thorpe resigns as Liberal leader 1981 MSM activity made legal (Scotland) 1981 First case of AIDS reported in the UK 1982 MSM activity made legal (NI) 1983 Gay men barred from donating blood 1984 Chris Smith elected as first openly gay MP 1987 Operation Spanner begins 1988 Section 28 comes into force 1989 Stonewall UK forms 1994 Age of consent for MSM becomes 18 1997 Angela Eagle becomes first openly lesbian MP 1998 Bolton 7 found guilty 1998 Lord Alli becomes first openly gay Lord 1999 Admiral Duncan bombing 2000 Gay men allowed in HM Armed Forces 2001 Age of consent equalised to 16 2001 MSM activity involving multiple men legal 2002 Same sex couples granted equal rights to adopt 2003 Section 28 repealed 2004 Civil partnerships introduced 2004 Gender Recognition Act 2004 2006 Discrimination made illegal 2008 Equalised access to IVF for lesbian couples 2008 Incitement to homophobic hatred made a crime 2009 Public apology to Alan Turing 2010 Equality Act 2010 2011 Gay men allowed to donate blood (1 yr deferral) 2013 Nikki Sinclaire becomes first openly trans MEP 2013 Marriage (Same Sex Couples) Act 2013 2014 First same-sex marriages take place 2016 MSM activity not grounds for military discharge 2017 Turing law implemented 2017 Blood donation deferral 3 months (excl. NI) 2019 MPs legislate for gay marriage in NI 2020 Gay marriage legal across UK, incl. NI 2020 Blood donation deferral 3 months (incl. NI) 2021 Blood donation deferral equalised
LGBTQ portal UK portal
v t e

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 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. ^ Doward, Jamie (3 November 2018). "Gender identity clinic accused of fast-tracking young adults". The Observer. ISSN 0029-7712. Retrieved 13 January 2020.
8. ^ Bannerman, Lucy (5 December 2020). "David Bell: Tavistock gender clinic whistleblower faces the sack". Times Newspapers Limited.
9. ^ 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.
10. ^ 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.
11. ^ "NHS 'over-diagnosing' children having transgender treatment, former staff warn". Sky News. 12 December 2019.
12. "Flood at the Tavistock Centre – Sunday 28 July 2019 | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
13. ^ "UK mom sues Tavistock children's clinic over 'misleading' & 'experimental' gender change treatments". RT International. Retrieved 13 January 2020.
14. ^ 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)
15. ^ "Update on the Judicial Review, Tuesday 1 December 2020". tavistockandportman.nhs.uk. Retrieved 8 December 2020.
16. ^ "About us | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
17. "Tavistock and Portman NHS Foundation Trust". www.cqc.org.uk. Retrieved 13 January 2020.
18. ^ "Gender Identity Development Service referrals in 2019-20 same as 2018-19". tavistockandportman.nhs.uk. Retrieved 26 February 2021.
19. ^ "Current debates | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
20. Entwistle, Kirsty (18 July 2019). "An open letter to Dr Polly Carmichael from a former GIDS clinician". Medium. Retrieved 13 January 2020.
21. Barnes, Hannah; Cohen, Deborah (19 June 2020). "NHS child gender clinic: Staff concerns 'shut down'". BBC Newsnight. BBC News. Retrieved 19 June 2020.
22. "Tavistock and Portman NHS Foundation Trust". www.cqc.org.uk. Retrieved 13 January 2020.
23. "About us | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
24. Bartosch, Josephine (5 December 2020). "Why I was right to blow the whistle on the Tavistock Clinic over puberty blockers". Telegraph Media Group Limited.
25. "Puberty blockers: Under-16s unlikely to be able to give informed consent 1 December 2020". BBC. BBC.
26. "Amnesty International UK and Liberty joint statement on puberty blockers". www.amnesty.org.uk. Retrieved 8 December 2020.
27. "Consortium Statement on Bell v Tavistock Outcome". www.consortium.lgbt. Retrieved 8 December 2020.
28. Topping, Alexandra. "HIgh court grants leave to appeal to UK gender identity service 19 January 2021". Guardian. Guardian. Retrieved 20 January 2021.
29. ^ "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)