There is a glaring omission in the failure of GIDS to utilise other, relevant specialist services provided by the Tavistock-Portman NHS Trust, eg. the ASD service:
tavistockandportman.nhs.uk/care-and-treatment/our-clinical-services/lifespan/
I suspect that this is primarily due to the way the NHS has been operating since the “internal market” was established in the late 1980’s, with separate contracting arrangements for different services.
It would not be impossible for arrangements to be agreed but the days are long gone when clinicians could just decide that they needed to work with colleagues in a different specialty in the same organisation and just go ahead and set something up.
That sort of joint working would make a lot more sense than hiving off the “ASD issue” entirely to local CAMHS. Local support would still be needed for each child. However, that sort of joint working would go a long way to preventing a service like GIDS becoming so narrowly focussed that it fails to take a holistic approach to individual children.
I have had considerable experience managing a comparable NHS service, ie. in terms of specialisation, contracting and commissioning rather than clinical focus, and I am all too aware of the serious, systemic obstacles to joint working. However, I trawled through all the documentation, minutes of meetings, etc. on the NHS Specialist Commissioning website and I could not find anything suggesting that anyone had recognised that the high incidence of ASD needed addressing.
This is something that should also have been raised within the Tavistock-Portman at Board level.
These children have such complex needs. It is horrifying to read what has been pulled from the Board minutes above, that they were viewed simply as raw material to help advance the Trust’s ambitions internationally.
There is a huge difference between “NHS culture” at Board level and “at the coal face”. At Board level the imperatives are primarily financial and corporate reputation. GIDS is very significant in both respects to the Trust so it will go all out to protect the income stream. This, I suspect, accounts for its recent decision to discipline David Bell, who has been critical of GIDS, even though he is due to retire shortly. A very convenient scapegoat and/or smokescreen?
From what I have seen of GIDS management on TV (Polly Carmichael and Bernadette Wren) I do not have any sympathy for them as they seemed complacent to the point of callous. However, the Trust Board and ultimately the Commissioners at NHS England bear primary responsibility for the design, aims, ethos and quality of GIDS services and the impact on individual children.
The Commissioners are supported by an Advisory Panel that includes “trans advocates”. I understand that applications from other “stakeholders” who would have provided some balance, such as detransitioners, have been rejected. NHS England needs to address the ideological capture of its commissioning process as a matter of urgency. NHS Gender Identity Services are being transformed from clinical services for adults and children with gender dysphoria into “trans services”.
The Commissioners are currently pumping money into piloting new, out-sourced “trans services” for adults. The specifications read more like “advocacy and social hubs” than NHS services.
That money would be better spent IMHO on rendering GIDS fit for purpose and supporting the growing number of detransitioners.
The “trans community” persecutes detransitioners and the NHS has a poor track record of supporting patients it has damaged. There isn’t a cat in hell’s chance of the NHS even considering the needs of detransitioners as long the Specialist Commissioners remain guided by trans activists and representatives of organisations with a vested interest in disregarding the existence and needs of detransitioners.
The GIDS “research” is yet another example of sweeping detransitioners under the carpet. Their excuse for failing to follow-up patients once they transferred to adult services is frankly pathetic. Mind, since GIDS was incapable of maintaining adequate records and data while these children were under its care it is no wonder they had neither the imagination nor motivation to arrange follow-up.
After venting all that - the next question is, what would a good service for children look like?
As far as I am aware, but happy to be corrected, the best data on outcomes is still Zucker’s 30 years of using the “watchful waiting” approach in Canada that sifted out those children whose dysphoria resolved on reaching puberty. However, this was before the “ROGD phenomenon” and the massive surge in referrals of peri and post-pubertal girls.
Detransitioners have such a lot to teach researchers and clinicians to help them understand this phenomenon. Another very good reason for the NHS to stop pretending that they don’t exist.
Apart from the usual suspects, eg. response to sexual abuse and unwanted sexual attention, the role of gay (male) porn and autoandrophilia must be considered, just as much as it’s better documented male equivalent.
The pretence that gender identity is always irrelevant to sexuality has to be dropped. It is really unhelpful to carry on as if the internet had not been invented.
Children of both sexes are being influenced by porn, not just traumatising, violent porn but also idealised, aspirational “anime” porn (I can never remember the names of all the sub-types but clinical practitioners need to be up to date if they are going to be able to work with these children effectively!)
Detransitioners are more honest about these influences, which is probably why trans activists try to shut them up, getting their social media posts and videos deleted and their accounts banned.
If the Tavistock-Portman Trust really wanted to get ahead of the game and up its international reputation then it should appoint an expert in cult deprogramming as joint head of GIDS.
The Commissioners also need a rude awakening from the spell cast by the assorted Cross Dreamers and acolytes who have been advising them. Any improvements to GIDS will depend on the Commissioners agreeing to fund changes.