The NHS is closing its gender identity clinic for children and young people and replacing it with a regional network after it was told that only having one provider “is not a safe or viable long-term option”.
The contract for the Gender Identity Development Service (GIDS) at the Tavistock & Portman NHS Foundation Trust will be brought to a close, the NHS said.
It said it intends to build a “more resilient service” by expanding provision into a regional network, and is taking “immediate steps” to establish two services led by specialist children’s hospitals in London and the North West.
The NHS aims for these to be fully up and running by Spring 2023.
It follows recommendations from Dr Hilary Cass, who is leading an independent review into Gender Identity Services for children and young people.
She said there was a need to move away from a model of a sole provider and that the number of children seeking NHS help “is now outstripping the capacity of the single national specialist service”.
In her interim report, released in March, she wrote: “It has 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.”
The NHS said the two new services are the “first step” in a national regional network “given the urgent requirement to stabilise current service provision for patients”.
The final number is yet to be decided but initial thinking suggests seven or eight services could be put in place.
One London-based service will be led by Great Ormond Street Hospital and Evelina London Children’s Hospital, with South London and Maudsley NHS Foundation Trust providing specialist mental health support.
A second service in the North West will be led by Alder Hey Children’s NHS Foundation Trust and the Royal Manchester Children’s Hospital, with both trusts providing specialist mental health services.
These will take over clinical responsibility for and management of all GIDS patients – including those on the waiting list.
Demand for support from GIDS has risen sharply over the last decade, with more than 5,000 referrals in 2021/22, compared with less than 250 in 2011-12.
The Cass review was commissioned in September 2020 amid the rise in demand, long waiting times for assessments and “significant external scrutiny” around GIDS’ approach and capacity, the NHS said.
The NHS said there was also a “lack of clinical consensus and polarised opinion” around the best model of care for children questioning their gender, and a “lack of evidence to support families in making informed decisions about interventions that may have life-long consequences”.
And it said there has been a “dramatic change” in who is being referred, with more children registered female at birth, neurodiverse children and children with mental health needs.
The review’s interim report warned that many of those being referred have complex needs but that, once they are identified as having gender-related distress, other healthcare issues “can sometimes be overlooked”.
And it said some health staff feel under pressure to adopt an “unquestioning affirmative approach”, and recommended they remain open and explore the patient’s experience and options.
Its final report is expected in 2023.
A GIDS spokeswoman said the service appreciates how difficult long waits are for young people seeking treatment, and the new measures represent “significant progress in expanding capacity”.
She said the trust supports the need for a more sustainable model amid the rise in referrals, adding: “Over the last couple of years, our staff in GIDS have worked tirelessly and under intense scrutiny in a difficult climate.
“We are proud of them and thankful for their unrelenting patient focus and extraordinary efforts.”
The NHS also said it will carry out clinical research that will track under-16s who are on puberty blockers into adulthood.
This was recommended by Dr Cass, who warned that without this the evidence gap “will continue to be filled with polarised opinion and conjecture, which does little to help the children and young people, and their families and carers”.
The NHS said it will ensure greater transparency around “the uncertain clinical benefits and longer-term health impacts surrounding their use”.
While the research is ongoing patients will continue to be able to access treatment, it added.