Young transgender people could be referred to safeguarding agencies if they access puberty blockers and hormone therapies on the private market after being told by a public health professional they should not be taking them, new draft guidelines from England’s National Health Service suggest.
If NHS professionals decide a patient should not be taking puberty blockers or hormone treatments obtained privately, they can advise the patient’s primary care doctor to initiate “safeguarding protocols”, according to draft guidelines seen by the Reuters news agency.
The draft does not spell out why safeguarding measures would be taken, or what they would involve. Under NHS protocols, “safeguarding teams” are made up of professionals from the police, medical and social services who are responsible for ensuring a child’s safety and wellbeing.
Other changes in the draft guidelines are said to include: allowing only NHS professionals to refer young people for gender care, proposing teams with wider professional expertise within the clinics, and requiring meetings between referring staff and a clinic to establish if gender clinics are the best route for treatment.
Asked for confirmation of the details of the guidelines, an NHS England spokesperson said the organisation could not comment on a draft. NHS England has previously said it would soon share its preliminary guidelines with the public to allow for feedback and revision, but it declined to answer when the guidelines would be published.
The draft prepared by NHS England states that “there is now an urgent need” to finalise the guidelines and help set up new services for transgender youth “as quickly as possible”. It was briefly uploaded to the NHS England website at the end of September, with plans for a 45-day public comment period, but later removed, Reuters reported.
The guidelines are part of a wide-ranging review of treatment for young transgender people seeking NHS care. The current approach, which can include medical interventions, has been criticised by some practitioners who said it rushed people on to medication, and by some families who argue that young people are facing years-long waits because the service cannot manage demand.
The waiting times have led some young people to seek medication or treatment privately or through unregulated online pharmacies.
In a statement earlier this week, the NHS England medical director, Dr Stephen Powis, said: “No one should be purchasing illegal, unknown and potentially life-threatening drugs online.”
The NHS is shutting down its only gender identity clinic for children in England, the Gender Identity Development Service (Gids), at the Tavistock and Portman NHS foundation trust from spring 2023 after it was criticised in an interim report by Dr Hilary Cass, who is leading an independent review of gender identity services for children and young people.
In a statement in July, NHS England said it intended to build a “more resilient service” by expanding provision, and would establish two services led by specialist children’s hospitals in London and north-west England.
A spokesperson for Gendered Intelligence, a national transgender-led charity, said people using or hoping to use the service urgently needed more information about how it would be run.
“The last thing anyone wants to see is a rehash of the same problems currently faced by Gids: a system with so many administrative barriers and capacity issues that it became unsustainable,” the spokesperson said. “It is crucial that the new services focus on accessibility and communication; on actually facilitating access to treatment and support rather than leaving young people and their families in limbo.”
