NHS say ignore parents even if child is not Gillick competent

[Datun]

It looks like The Telegraph has access to a lot of the FOI results. This can't go on, surely.

NHS staff are being advised to ignore parents’ wishes if they conflict with those of a child who identifies as transgender - even if the child is not considered to have the understanding and intelligence to consent

The policy of Rotherham NHS Foundation Trust states: “Where appropriate the wishes of the parents must be considered, but in the case of young people their preference should prevail.”

Adolescents might prefer to spend most of their day time in mixed areas, but must have access to same gender sleeping area, treatment rooms and sanitary facilities.”

www.telegraph.co.uk/news/2019/01/11/nhs-staff-advised-ignore-parents-wishes-children-self-declare/

from the Daily MAil article:

‘If you aren’t even considering other groups in your equality impact assessments, your policy cannot be lawful,’ said Amanda Jones, a barrister at Great James Street Chambers in London.

The NHS’s interpretation of laws about the rights of transgender patients is ‘a mess’, she added.

Quite!

www.dailymail.co.uk/news/article-6579807/Men-self-identify-women-routinely-NHS-hospital-wards-females.html

This is not a new policy. It seems to have been put in place in 2009 in this Department of Health document.

<a class="break-all" href="https://web.archive.org/web/20091105195026/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098893.pdf" rel="nofollow" target="_blank">web.archive.org/web/20091105195026/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098893.pdf

On page 12:
In some instances, parents or those with parental responsibility may have a view that is not consistent with the child’s view. If possible, the child’s preference should prevail even if the child is not Gillick competent.

They really have been working on this for a long time.

Didn't see this earlier - got the wrong paper today!

Joanie Walsh tweeted that there was more to come yesterday.

There was also something about an article that was not online yesterday; about police crime statistics counting violent offenders by their self-identity - they had thought it was something to do with PACE. She was hoping to get it online. Will keep a lookout.

The good news is that the GMC guidance on consent seems more balanced. Clearly medical staff have to comply with GMC guidance...

www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/0-18-years/making-decisions

They really have been working on this for a long time.

I hope Camilla Tominey and Joani Walsh avail themselves of the resources here.

It's not just Rotherham.

It's National NHS policy. Since 2009.

The NHS documents are all linked in this article from last year.
I'm glad that the Telegraph have now given the subject a wider audience.

medium.com/@anneharperwright/sex-gender-the-nhs-1e8f4e6363a6

Particular considerations for children and young people
Gender variant children and young people should be accorded the same respect for their self-defined gender as are trans adults, regardless of their genital sex.
Where there is no segregation, as is often the case with children, there may be no requirement to treat a young gender variant person any differently from other children and young people.
Where segregation is deemed necessary, then it should be in accordance with the dress, preferred name and/or stated gender identity of the child or young person.
In some instances, parents or those with parental responsibility may have a view that is not consistent with the child’s view. If possible, the child’s preference should prevail even if the child is not Gillick competent.

It is no surprise that individual trusts have all taken this approach. You could submit a hundred FOIs and you'd find they've all taken the same approach, because as the original Medium article revealed, this has been driven from the top down, and was put in place a decade ago.

It's a national directive.

I keep starting to write, but can't find the words.

I should be unshockable, but HCPs are now instructed to ignore basic principles of consent regarding the treatment of children? If a child is not capable of consent, that means there is a problem with the child's understanding, or they cannot retain information/weigh up risks versus benefits/convey their decision. Perhaps because the child is far too young.
Honestly, most adults cannot grasp the concepts around transgenderism. Do children even understand the difference between sex and this nebulous gender identity business? My money is on NO.
So what is happening here is that professional ADULTS who are part of a government health agency are ignoring the people who know the child best (the parents), even though the child has been found to not have an appropriate comprehension of the subject!

How in the world is this allowed?

Early social transition, in my view, especially if reinforced by medics, means that a child could get locked on one pathway. This is despite the fact that according to GIDS only about 16% of children across all studies continue with their cross-gender identity. Could this increase with more early intervention? It seems likely. The pathway to transition including puberty blockers, which seem to increase the chance of children "graduating" to taking cross-sex hormones (even though they are advertised as only temporary), which can lead to permanent changes including sterility and removal of otherwise healthy organs in operations that have their own risks. All of this is essentially experimental, with little-to-no long-term data.

GIDS say that one should use a watch and wait approach for young children.
gids.nhs.uk/evidence-base

The age at which adolescents socially transition has decreased in the last decade. Steensma & Cohen-Kettenis (2011) report that between 2000 and 2004, out of 121 pre-pubertal children, 3.3% had socially transitioned (clothing, hairstyle, change of name, and use of pronouns) when they were referred, and 19% were living in the preferred gender role in clothing style and hairstyle, but did not announce that they wanted a change in name and pronoun. Between 2005 and 2009, these percentages increased to 8.9% and 33.3% respectively.

However, quantitative and qualitative follow-up studies by Steensma et al (2011; 2013) present evidence to strongly suggest that early social transition does not necessarily equate to an adult transgender identity. The qualitative study reports on two girls who had transitioned when they were in elementary school and struggled with the desire to return to their original gender role. Fear of teasing and feeling ashamed resulted in a prolonged period of stress. One girl even struggled to go back to her previous gender role for two years.

As such, in our approach, we would encourage exploration of gender roles in this younger cohort, with a view to keeping options open and not having any pre-conceived ideas as the longer term outcome.

I'm in no doubt they will, Datun.

At the risk of sounding churlish, can I please direct people to the original Medium articles on this.
The story broke there, in October, to very little fanfare. Shared on twitter, here on Mumsnet, and no journalists were interested at that time.

The writer of those original Medium articles has included a lot of data, and far more information than the Telegraph articles today and yesterday.

She's unpaid. She writes and investigates for free.
She's a mumsnetter.

Early social transition, in my view, especially if reinforced by medics, means that a child could get locked on one pathway.

From what I have read, social transition is the biggest, most overwhelming indication of subsequent medical intervention.

And this is not even to mention the health education aspect of this!
If a child is being essentially alienated from the truth of their actual biology (sex), and healthcare professionals are actively colluding in this belief, how is the child supposed to relate to their actual body including reproductive system?

From what I have read, social transition is the biggest, most overwhelming indication of subsequent medical intervention.
I've mentioned that a few times. I think we underestimate the impact taking on a whole new identity has on a child. As an adult, women write about how motherhood changes their self perception, how marriage does, how old age does.
We're talking about kids here, with unformed, plastic brains, taking on a new name, new title "son" or "daughter", explaining this to their whole family, all their school friends, and keeping it up all the time.
It must be a terrible strain, and it must affect them psychologically. No wonder few of them want the hassle of going back to who they were, especially if they're a few years older - once you were eight there's no way you could relate to yourself at five!
As adults we have hindsight and can remember both five, eight, fifteen and eighteen and how daft we were at each age.
I wouldn't wish the stress of transition on any child. Social, medical or surgical.

At the risk of sounding churlish, can I please direct people to the original Medium articles on this.
The story broke there, in October, to very little fanfare. Shared on twitter, here on Mumsnet, and no journalists were interested at that time.

Barracker I had similar thoughts.

Your thread with link to Anne Harper Wright's article and research:
Barracker Tue 16-Oct-18
medium.com/@anneharperwright/sex-gender-the-nhs-1e8f4e6363a6

"They were ALWAYS based upon 'gender'.
The evidence is in NHS documents from 2010.
And the Department of Health were told, by the NHS team, not to tell people wards were segregated by sex, because they knew the policy was based on gender.

But the DOH purposefully used the word sex to the public instead.

We've been deliberately misled."

www.mumsnet.com/Talk/womens_rights/3396859-Weve-been-lied-to-about-Single-SEX-wards-since-2010

There has been discussion on a number of MN FWR threads with evidence of the NHS policies (including the one which is the subject of the thread)
Fairplay For Women have also raised this.

She's unpaid. She writes and investigates for free.
She's a mumsnetter.

I would like to thank her for such important work and send &

Thanks Barracker for that important point.

And yes, huge THANK YOU to the author of the Medium articles who goes by Anne Harper-Wright. AMAZING WORK.

One of the articles was discussed on this thread, I think:
www.mumsnet.com/Talk/womens_rights/3422736-My-NHS-Medical-Record-has-deleted-my-sex-And-added-a-ladybrain

Thanks for the reminder. You're a star Anne. This is all part of a concerted effort to move the U.K. away from the current watchful waiting approach and towards the affirmative approach used in the US. It's what Mermaids have said they're lobbying for (yet another reason why they shouldn't get cash which is ring-fenced against political lobbying)

Gillick/Fraser competence is often poorly understood by health professionals.

The competence test requires the individual to understand and evaluate the risks of having (or refusing to have) a procedure.

I would argue that anyone who thinks they can change sex is not competent to consent to any treatment.

Thanks Barracker for that important point.

Also from me. And thanks to Anne also.

Yes indeed. Here is the breaking news.

medium.com/@anneharperwright/sex-gender-the-nhs-1e8f4e6363a6

Journalists appear to have ignored it at the time.

On the back of Baracker's research, I see RedToothBrush suggesting:

How do we FOI this shit out of this?

A lot of this is about resources, isn't it?

The Telegraph has them.

I meant don't have capacity to consent at any age, but surely very few teenagers would fully understand the complex risks involved.

How can they be assessed as competent?

No one understands the risks involved. Because there are no long-term studies on what they bloody well are.

On the back of Baracker's research, I see RedToothBrush suggesting:

How do we FOI this shit out of this?

A lot of this is about resources, isn't it?

The Telegraph has them.

On the back of the Telegraph and Daily Mail articles, couldn't people contact their local hospital's PALS and ask them to obtain the relevent single sex accomodation policies & transgender policies?

‘If you aren’t even considering other groups in your equality impact assessments, your policy cannot be lawful,’ said Amanda Jones, a barrister at Great James Street Chambers in London.

The NHS’s interpretation of laws about the rights of transgender patients is ‘a mess’, she added.

From a bird’s-eye view, it looks like a gathering of different but related interests, each feasting on a part.

Add in intentionally detaching the child from the family and parents, and setting precedents around removing parental responsibility and the right of professionals to put the parents aside if their views/choices are inconvenient.

That isn't supported in the Code of Practice (law for every agency working with children), where working with parents and respecting parental choice is key. It isn't supported in the family court either. Older children are not allowed to decide not to have contact with an abusive parent, they're not considered competent to foresee the long term consequences of the choice.

This is actively against standard UK legal practice in every other area involving children.

Also worth remembering that (hideous) 'how to get paedophilia accepted' manifesto. One of the key points was loosening family bonds as parents are the key barriers getting in the way of predators accessing children.