Children will only be referred to trans clinics if their parents agree under planned overhaul of NHS rules

Children will only be referred to transgender clinics if their parents agree, under a planned review of NHS rules.

Teachers, social workers and GPs have been able to send children to Tavistock's gender identity service without parental consent.

But new plans set out in a public consultation document say children will only be referred if they, their parents and a specialist agree it is in the child's best interests, in two separate assessments.

It is the latest in a series of proposals to reform children's services, following a scathing review by Dr Hilary Cass, the former president of the Royal College of Paediatrics and Child Health.

Her interim report found that the approach under the Tavistock put patients at 'significant risk' of poor mental health and was not a 'safe or viable long-term option'.

Figures released last month by University College London show the number of newly registered transgender identities between 2000 and 2018, by age group. In 2000, there were 1.45 new cases of transgender identification per 100,000 person-years. But this figure increased fivefold to 7.81 cases per 100,000 in 2018

The service, which is based at Tavistock and Portman NHS Foundation Trust in north London and is the only one of its kind in England, will close in March and be replaced by two regional sites.

Experts have criticized the clinic's 'positive' approach to treating children with perceived gender dysphoria, where they feel they are not the same gender as they were born, and the lack of research into alternative health conditions before children are given puberty blockers.

Under a new 'referral advice service', children who may be referred to a gender service will receive a 'consultation, advice and liaison interview'.

This involves parents, doctors and the child agreeing on the best way forward, deciding whether or not this involves a referral to a children's gender service, and then developing a care plan that includes other services that can be accessed while on the waiting list to stand.

The consultation document, published this week by NHS England, states that these steps are necessary 'in view of the relatively large numbers of children and young people presenting to gender incongruent services with other complex needs such as mental health, neurodiversity or autism'.

It adds that it will also help address concerns raised by the Care Quality Commission 'about the lack of support or risk assessment' for children on a waiting list.

Previously, children did not need parental consent to be referred to the Tavistock, and in some cases there was no need to start puberty blockers.

The service temporarily introduces a maximum age of 16, with teenagers aged 17 being referred to an adult clinic.

Any children who have already been referred to a gender identity service and are yet to be seen will not be subject to the new referral restrictions, the NHS said.

It is thought that as many as 8,000 are in this situation.

An NHS spokesperson said: 'These proposals are designed to ensure that children who may be experiencing issues with their gender identity are appropriately connected to local services and are referred, age-appropriately, to the new specialist gender service that goes live next year.

'In a separate consultation, NHS England has also proposed that the new specialist children's gender service will not be able to routinely provide any medical intervention, including the use of puberty blockers, to children under the age of 16.'