Transgender children are being left in a “far worse position” than before the Cass report, with a service that is “going backwards instead of forwards”, according to a psychologist who has set up a private gender service.
Dr Aiden Kelly, a clinical psychologist specialising in gender who was part of the team at the Tavistock and Portman NHS mental health trust’s gender identity development services (Gids), said he was “very, very worried” about the NHS’s ability to deliver a suitable gender service based on the findings of the Cass review.
The report, released on Wednesday, gave more detail on previous recommendations that the now-closed Gids clinic be broken up into regional hubs. Between the closure of Gids and the setting up of the new clinics, waiting lists have lengthened and some children have been moved to adult services in an effort to cope with demand.
“We’re in a far worse position than we were four years ago,” he said. “The Cass review and NHS England’s policy updates, and the kind of measures and decisions they’ve made in terms of what to do with services, how to set up services – or not, as the case may be – means we’re in a far worse position.”
The Cass report was critical of private provision, noting many parents had felt “forced” into choosing that route because of years-long waiting lists for their children at Gids. In an interview with Radio 4’s Today programme on Wednesday, the author of the report, the leading consultant paediatrician Hilary Cass, said: “Everybody should be getting the same standard of care. And I do have concerns about private provision, which is not providing the level of assessment that I’m recommending in the NHS.”
However, there are currently 5,000 children on the waiting list for the regional services, which had been due to open in spring but were pushed back due to what the report described as the “complexity” of opening clinics from scratch.
She added: “I fully understand why parents have felt that going down that path is the best way to serve their children … We have asked NHS England to provide advice to families about what it means if they go down a private route in terms of coming back into the NHS later.”
The report warned parents to avoid turning to unregulated routes, such as buying hormones from the internet, and for GPs to ensure they were acting in the child’s best interest when working with a private clinic that is prescribing hormones.
In 2019, only 16% of those referred to Gids started hormone treatment, said Kelly, whose clinic does not prescribe puberty blockers, “so it doesn’t fit with the narrative that people were rushed on to treatments, that everyone just got it handed out like candy, how you hear some people talk about it.
“It was the exact opposite to that.”
Kelly, who now runs an independent gender service, Gender Plus, with some former colleagues, said there was an “unjustifiable” level of caution from the Cass report that did not match his experience in the service and that poor outcomes had been overemphasised, leaving England “out of step” with the rest of the world.
He said: “It’s important to remember that people carrying out this expert review have never worked in gender. The people who actually know the work, and have been doing the work for a long period of time, don’t hold that level of caution and fear.”
Kelly, who has specialised in gender for nine years and previously worked in mental health, added: “Yes, more research is needed. But not at the cost of actually offering meaningful care.”
He said the vast majority of young trans people who had been benefitting from the service were now “paying the biggest price”.
In the years between the launch of the Cass review in 2020 and now, the help on offer to young trans people had diminished dramatically, Kelly said, which was “disappointing”.
“The decision to get rid of [Gids] and start afresh with two services with no history, no expertise in the field, with hiring clinical teams who have never worked in gender before, [who would be seeing] a much greater and much longer list of referrals, doesn’t sound to me like a successful approach and it really seems like we’re going backwards instead of forwards.”
He added: “You’re going to have people who’ve been waiting over four years to see a gender specialist; they’ll arrive at one of these new gender clinics and they may well know more about the field of gender than the clinician will and that’s not an exaggeration. That, to me, is incredibly worrying.”
