The NHS in England is shutting down its gender identity clinic for children after a review found that it failed vulnerable under-18s.
The gender identity service at Tavistock & Portman NHS Foundation Trust in London has been ordered to close by next spring.
It will be replaced by regional centres at existing children’s hospitals offering more “holistic care” with “strong links to mental health services”.
Tavistock’s Gender Identity Development Service (GIDS) clinic has been accused of rushing children into life-altering treatment on puberty blockers.
The paediatrician Dr Hilary Cass, who is leading a review of the service, issued a series of recommendations today for a radical overhaul of how the NHS treats young people who are questioning their gender identity.
She found that the Tavistock clinic was “not a safe or viable long-term option” and that other mental health issues were “overshadowed” when gender was raised by children referred to the clinic.
Ms Cass, former president of the Royal College of Paediatrics and Child Health, said the existing model of a sole provider for gender services should be scrapped as it failed to meet the holistic needs of distressed and vulnerable teenagers.
She said Tavistock should be replaced by regional centres with an “appropriate multi-professional workforce to enable them to provide an integrated model of care that manages the holistic needs of this population”.
Amid concerns that the clinic fails to take into account wider health problems before putting children on puberty blockers, Ms Cass added: “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.”
NHS England, which commissioned Ms Cass to review the service in September 2020, said it will implement her recommendations in full and decommission the Tavistock clinic.
It has announced the launch of two clinics for children with gender dysphoria by next spring, which will bring together multiple doctors from a broad range of specialities.
The first, in London, will be based at Great Ormond Street Hospital and receive specialist mental health support from the South London and Maudsley NHS Foundation Trust.
The second, in the northwest, will be led by a partnership between Alder Hey Children’s NHS Foundation Trust in Liverpool and the Royal Manchester Children’s Hospital.
Ms Cass said these clinics must have “established academic and education functions” to monitor evidence on children who are put on hormone therapy. The Tavistock clinic failed to collect sufficient data on the impact of puberty blockers in under-16s.
She said there was “insufficient evidence” for her to make any firm recommendations around their routine use.
Ms Cass told the NHS to “enrol young people being considered for hormone treatment into a formal research protocol with adequate follow-up into adulthood, with a more immediate focus on the questions regarding puberty blockers”.
The NHS said it would launch clinical trials in partnership with the National Institute for Health and Care Research to follow children on puberty blockers into adulthood. “This will ensure that there is greater transparency for children and their parents/carers around the uncertain clinical benefits and longer-term health impacts surrounding their use,” a spokesman said.
The clinic has been overwhelmed by a sudden increase in referrals, particularly among young girls and children on the autism spectrum. Last year it received more than 5,000 referrals, compared with 250 a decade ago.
Ms Cass’s final report will be published next year. Her interim review published in March found that services had developed without clear rules and that there was a “clinician lottery”, with widely varying approaches to treatment.
She found there was “a lack of agreement, and in many instances a lack of open discussion” about whether unhappiness with gender in adolescence was permanent or temporary.
However, last year the Court of Appeal overturned a ruling made by the High Court that children under 16 were unlikely to be able to give informed consent to receiving puberty blockers.
The case was brought against the Tavistock and Portman trust by Keira Bell, 24, who began taking puberty blockers when she was 16 to transition to male before later “detransitioning”.
A spokeswoman from the Royal College of Psychiatrists said: “Current waiting times for children and young people seeking support from gender identity services are entirely unacceptable. Any action to reduce waiting times and bring these vital services closer to where patients live are welcome.
“It is important to recognise that gender dysphoria is not a mental health disorder, though psychiatrists may be asked to be involved in a patient’s care to help with co-occurring mental health problems. The College will continue to support psychiatrists in fully exploring their patient’s gender identity, involving their families where appropriate, in a non-judgmental, supportive, and ethical manner.
“While gender-affirming medical interventions improve wellbeing and mental health in transgender and gender diverse adults, more evidence is needed on the management of gender-diverse children, particularly those who have not gone through puberty.
"We welcome today’s announcements to strengthen research in this area to ensure children and young people can receive the best possible standard of care.”