Transgender children are in a “much worse position” than before the Cass report, with the service “going backwards instead of forwards”, according to a psychologist who set up a private gender service.
Dr. Aiden Kelly, a clinical psychologist specializing in gender who was part of the Gender Identity Development Services (Guide) team at Tavistock and Portman NHS Mental Health Trust, said he was “very, very concerned” about the NHS’s ability to to offer a suitable solution. gender service based on the findings of the Cass review.
The report, released on Wednesday, provided more detail on previous recommendations to split the now-closed Guide clinic into regional hubs. Between the closure of Gids and the establishment of the new clinics, waiting lists have lengthened and some children have been transferred to adult facilities in an attempt to meet demand.
“We are in a much worse position than we were four years ago,” he said. “The Cass review and the policy updates from NHS England, and the kind of measures and decisions they have taken in terms of what to do with services, how to set up services – or not, as the case may be – means that we are in a much worse position.”
The Cass report was critical of private provision, noting that many parents had felt ‘forced’ to choose that route because of the years-long waiting lists for their children at Gids. In an interview with Radio 4’s Today program on Wednesday, the report’s author, leading pediatrician Hilary Cass, said: “Everyone should receive the same standard of care. And I am concerned about private facilities, which do not provide the level of assessment I recommend in the NHS.”
However, there are currently 5,000 children on the waiting list for the regional services, which were due to open in the spring but were postponed due to what the report described as the “complexity” of opening clinics from scratch.
She added, “I completely understand why parents feel like taking that path is the best way to serve their children. later back into the NHS.”
The report warned parents not to turn to unregulated routes, such as buying hormones over the internet, and for GPs to ensure they act in the best interests of the child when working with a private clinic that prescribes hormones.
In 2019, only 16% of those referred to the Guide started hormone treatment, says Kelly, whose clinic does not prescribe puberty blockers, “so it doesn’t fit the narrative that people were rushed into treatment, that everyone just got it. looks like candy, how you hear some people talk about it.
“It was the exact opposite.”
Kelly, who now runs an independent gender service, Gender Plus, with a number of former colleagues, said there was an “unwarranted” level of caution from the Cass report that did not reflect his experience at the service and that too little emphasis was placed on the poor results, leaving England “out of step” with the rest of the world.
He said: “It is important to remember that the people conducting this expert review have never worked with gender before. The people who actually know the work and have been doing the work for a long time are not so cautious and afraid.”
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Kelly, who has specialized in gender for nine years and previously worked in mental health, added: “Yes, more research is needed. But not at the expense of actually providing meaningful care.”
He said the vast majority of young transgender people who had benefited from the service were now “paying the ultimate price”.
In the years between the launch of the Cass Review in 2020 and now, support for young trans people had declined dramatically, Kelly said, which was “disappointing”.
“The decision to abolish (Guide) and start again with two services with no history, no expertise in this area, hiring clinical teams who have never worked in the gender field before (who would see) a much larger and much longer list of referrals, does not seem to me to be a successful approach and it really seems like we are going backwards instead of forwards.”
He added: “There will be people who have been waiting for four years to see a gender specialist; they end up in one of these new gender clinics and may know more about gender than the doctor, and that’s not an exaggeration. I find that incredibly worrying.”