The revelations by brave whistleblowers that finally brought disgraced gender clinic Tavistock down

The UK’s sole child gender clinic was ordered to close it doors yesterday following more than a decade of allegations that it rushed teenagers onto life-altering puberty blocking drugs.

It was finally brought down after a probe into claims from brave whistleblowers who had been raising concerns about practices at the trust for 17 years. 

North London-based Gender Identity Development Service (GIDS), part of the Tavistock and Portman NHS Foundation Trust, has treated 9,000 children as young as 10 since it opened in 1989.

But it has faced a myriad of accusations from staff and former patients, with patients claiming they were rushed to change gender without having their mental health properly assessed.

Medics described a ‘climate of fear’ about being labelled transphobic by managers and colleagues if they dared to question the service’s approach. 

Dr Hilary Cass, a top paediatrician leading an NHS-commissioned review into Tavistock, last week told health chiefs that the centre needed to be overhauled after speaking with dozens of whistleblowers.

Concerns were first raised about the clinic in 2005, when Sue Evans, a nurse at GIDS warned that youngsters were being assessed too quickly and their treatment was influenced by transgender rights groups.

She accused staff, some of whom she said previously worked at transgender charities such as Mermaids and Gendered Intelligence, of immediately affirming children’s beliefs, rather than trying to understand all the difficulties the child was experiencing. Some referred patients for puberty blockers after just four appointments.

The drugs pause physical changes in puberty, such as the development of breasts or facial hair. Rishi Sunak and Liz Truss, who are vying to be the next Prime Minister, last night vowed to crack down their use in children, hinting that they could be outright banned for under-18s.

Concerns were first raised about the clinic in 2005, when Sue Evans (left), a nurse at GIDS warned that youngsters were being assessed too quickly and their treatment was influenced by transgender rights groups. In February 2019, an internal report by Dr David Bell (right), who was on Tavistock’s board, set out how patients were suffering ‘long term damage’ because GIDS could not ‘stand up to the pressure’ from ‘highly politicised’ campaigners and families. He argued that some of the trust’s patients were adopting a trans identify ‘as a solution’ to ‘multiple problems’ including past child abuse, bereavement and homophobia

Dr Marcus Evans — who had worked at the trust for decades and whose wife Sue first raised concerns about its practices in 2005 —  accused the trust of creating a ‘climate of fear’ and trying to ‘dismiss or undermine’ concerns, while 25 other clinicians signed a letter complaining about the attitude of managers

Little is known about their long term effects and almost all patients who receive them go on to start treatment with cross-sex hormones, which cause irreversible changes such as breast development and deepening of the voice. They can also cause infertility.

Mrs Evans flagged her worries to Tavistock’s clinical management team but they only became public years later.

In February 2019, an internal report by Dr David Bell, who was on Tavistock’s board, set out how patients were suffering ‘long term damage’ because GIDS could not ‘stand up to the pressure’ from ‘highly politicised’ campaigners and families.

He argued that some of the trust’s patients were adopting a trans identity ‘as a solution’ to ‘multiple problems’ including past child abuse, bereavement and homophobia. 

Dr Bell accused the trust of providing ‘woefully inadequate care’ and that staff had ‘very serious ethical concerns’ about children making life-changing decisions with inadequate assessment or consent. 

Later that month, consultant psychotherapist Dr Marcus Evans — who had worked at the trust for decades and whose wife Sue first raised concerns about its practices in 2005 — resigned in protest at the Tavistock’s response to doctors who raised the alarm. 

He accused the trust of creating a ‘climate of fear’ and trying to ‘dismiss or undermine’ concerns, while 25 other clinicians signed a letter complaining about the attitude of managers. 

Following the publication of his report, Dr Bell received letters threatening disciplinary action, including vague allegations of bullying.

His warnings triggered a subsequent report by Dr Dinesh Sinha, the trust’s medical director. But while this admitted staff had ‘excessive’ workloads and faced lobbying, he concluded the service was safe.

But the trust continued to come under fire.

In July 2019, Dr Kirsty Entwhisle, a psychologist at GIDS’ Leeds branch, went public with accusations that staff misled patients and made decisions about young people’s ‘bodies and lives’ without ‘robust evidence’.

She said some of the children had suffered ‘very traumatic early experiences’, such as being abandoned by their parents, sexual abuse, domestic violence or poverty.

These factors were ‘minimised or dismissed’ by staff, who referred patients for treatment without exploring or addressing these problems.

Medics who suggested children’s early experiences were linked with their desire to transition were at risk of being ‘called transphobic’, Dr Entwhisle said.

Staff were also telling their patients that hormone blockers were ‘fully reversible’ when experts still do not yet know the impact they of on children’s brains, she claimed.

In October 2019, Sue Evans and the anonymous mother of a 15-year-olds patient launched the first legal action against Tavistock. They claimed the trust should not prescribe puberty blockers to children who could not give informed consent.

Keira Bell, who was given the drugs when she was 16, replaced Mrs Evans as lead claimant in January 2020.

In July 2019, Dr Kirsy Entwhisle (left), a psychologist at GIDS Leeds hub, went public with accusations that staff misled patients and made decisions about young people’s ‘bodies and lives’ without ‘robust evidence’. She said some of the children had suffered ‘very traumatic early experiences’, such as being abandoned by their parents, sexual abuse, domestic violence or poverty, which were ‘minimised or dismissed’ by staff, who referred patients for treatment without exploring or addressing these problems. Sonia Appleby (right), the trust’s safeguarding lead, filed a claim with an employment tribunal after trust managers tried to stop her from carrying out her role when staff raised concerns. Last September, the tribunal awarded her £20,000, ruling that she had been treated unfairly

Keira Bell, who was prescribed the drugs when she was 16-years-old, replaced Mrs Evans as lead claimant in January 2020. She underwent breast-removal surgery but regretted transitioning, claiming she was given puberty blockers after ‘superficial conversations’ with social workers’ and was receiving testosterone shots a year later’. Ms Bell, who said she was suffering from anxiety and depression at the time, said medics should have considered her comorbidities, ‘not just reaffirm my naive hope that everything could be solved with hormones and surgery’. She said Tavistock ‘failed to protect young patients’ and had ‘conducted what amounted to uncontrolled experiments on us’ 

Ms Bell had undergone breast-removal surgery but regretted transitioning, claiming she was given puberty blockers after ‘superficial conversations’ with social workers and was ‘receiving testosterone shots a year later’.

The former patient, who said she was suffering from anxiety and depression at the time she received treatment, said medics should have considered her mental health issues, ‘not just reaffirm my naïve hope that everything could be solved with hormones and surgery’.

She said Tavistock ‘failed to protect young patients’ and had ‘conducted what amounted to uncontrolled experiments on us’. 

Ruling on the claim in December 2020, the High Court decided that under-16s could not give informed consent to the treatment. 

But Tavistock appealed the decision and it was overturned by the Court of Appeal in September 2021, claiming the previous ruling was ‘inappropriate’ and placed patients, parents and medics in a ‘very difficult position’.

Last January, the UK’s health watchdog, Care Quality Commission, gave GIDS an ‘inadequate’ rating — the lowest possible.

It found ‘significant concerns’ about how it operates and demanded improvement, with 4,600 children on the waiting list, who were deemed at risk of self-harm, facing waits of up to two years.

The CQC warned that staff had not always fully logged the competency, capacity and consent of patients receiving treatment or the reasons for their clinical decisions so it was impossible to understand why decisions had been made.

Its investigation came after the Children’s Commissioner for England raised concerns about GIDS clinical practice, safeguarding procedures and how it assessed its capacity and consent to treatment. 

Meanwhile, Sonia Appleby, the trust’s safeguarding lead, filed a claim with an employment tribunal after trust managers tried to stop her from carrying out her role when staff raised concerns. 

Last September, the tribunal awarded her £20,000, with the court ruling that she had been treated unfairly. 

In a move that finally saw GIDS ordered to close its doors, Dr Cass, a former chair of the Royal College of Paediatrics and Child Health who is conducting an independent review into GIDS, wrote to health leaders last week, saying its work needs to be overhauled.

The health service commissioned the report in autumn 2020 to examine its gender identity services following a spate of scandals.

In an interim report in March, Dr Cass hit out at the lack of ‘open discussion’ at the trust about its treatment, which was not subject to quality controls. 

She found other mental health issues were ‘overshadowed’ in favour of gender identity issues when children were referred to GIDS.

She called for a ‘fundamentally different service model’ and ‘rapid’ research on the use of the drugs after she found ‘insufficient evidence’ on their benefits.

The letter to NHS England last week called for regional centres to be commissioned for gender identity treatment, with ‘strong links’ to mental health services and academic hubs that conduct ongoing research.

The NHS yesterday confirmed that GIDS will be replaced by these local hubs at existing children’s hospitals, which will provide more holistic care with ‘strong links to mental health services’.

NHS England said it would set up two new centres in London and the North West. 

They will take responsibility for all of Tavistock child trans patients and waiting lists with the aim to shut down the clinic by next spring. 

GIDS’ London service will be run by a partnership between Great Ormond Street Hospital for Children and Evelina London Children’s Hospital.

In the North West, the service will be a partnership between Alder Hey Children’s NHS Foundation Trust and Royal Manchester Children’s Hospital.

After these initial two, a further six or seven similar services could be opened in other parts of the country.

Patients currently being treated at GIDS will continue to be treated by the service before their care is transferred to the new operators early next year.

GIDS has said there are currently no plans to change access to puberty blockers until the research programme proposed by Dr Cass is designed.

The closure of the service for young people at Tavistock is likely to be seen as a victory by campaigners who have previously accused GIDS of rushing children onto puberty blocking drugs. 

A spokesperson for GIDS said: ‘The trust supports the need to establish a more sustainable model for the care of this group of patients given the marked growth in referrals.’

‘The expertise that resides within the current GIDS service will be critical to the successful formation of these early adopter services and providing continuity in patient care.

‘We will work closely with partners and commissioners to ensure a smooth transition to the new model of delivery.’

They also added the team at GIDS were extremely proud of their work despite the ‘intense scrutiny’ they had been under.

‘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.’