Internal report into GIDS

[EweSurname]

GIDS Review Action Plan
29 March 2019

In the last 18 months the Gender Identity Development Service (GIDS) at The Tavistock & Portman NHS Foundation Trust has worked very hard to adapt and strengthen structures and processes to accommodate a very rapid expansion in the Service and a more diverse and complex patient population.

This week the Board has agreed an action plan to build on the efforts the Service has been making and further improve the care offered to patients.

The action plan, announced to staff today and affecting all areas of the Service, will improve and formalise operational procedures and ensure consistency of approach across a rapidly growing workforce.

Paul Jenkins, Chief Executive of Tavistock & Portman NHS Foundation Trust, said:

"The Gender Identity Development Service is a safe and highly specialised clinic for young people who have difficulties with their gender identity development – a complex and diverse patient group.

"The Trust’s newly appointed Medical Director was commissioned to carry out a Review to explore concerns raised by a member of staff external to the Service.

"The Review did not identify any immediate issues in relation to patient safety or failings in the overall approach taken by the Service in responding to the needs of the young people and families who access its support.

"It has, however, identified some important areas where further improvements could be made in the operation of the service.

"The Action Plan announced today will see the Trust implement all the recommendations within the next 12 months."

tavistockandportman.nhs.uk/about-us/news/stories/gids-action-plan/

18. There was a relatively common view that it was possible to extend this frame for the initial assessment, leading up to an assessment report and that there were no overt problems in doing an extension of the frame. Intervieweesreferred to the NHSE protocol, as guiding the service design and model, while making it clear that it was not purely a diagnostic service but rather attempting to provide flexibility to allow exploration. However, several interviewees felt a sense of implicit pressure from seniors to maintain throughput and keep to the frame rather than extend, due to the pressure of the waiting list.

19. Certain issues where concerns had not been addressed, such as the adequate exploration of sexuality within clinical settings was brought up in the member of staff’s paper. In exploring this issue, there seemed no particular concerns held by a majority of interviewees around there being a lack of sufficient openness to hearing about the experience of homophobia by clinical staff within face to face clinical meetings.

20. However, some interviewees stated that the response to complaints from family members and young people was to remove the clinicians involved and reallocate the case to others. There was concern that this was perceived and experienced, as less than robust enough support from the senior leadership team for clinicians facing issues in exploring gender dysphoria.

21. Some interviewees expressed concerns about the use of hormone blockers and their consideration, as providing an
    interregnum for further exploration of gender dysphoria.
    Evidence provided by the service appeared to support the shift in impact of using hormone blockers, in that a majority of young people then went on to have cross sex hormones.

22. There were also some concerns expressed about the lack of uniform process beyond team discussion and that there was no mandatory need for gaining signed consent from young people and their families at GIDS. There was a process of taking signed consent at endocrine clinic and I have seen evidence of documentation used.

23. Several interviewees were aware of issues of longer-term difficulties with consent, particularly with young people and their understanding of issues, such as fertility and its impact on their adult lives. Clinicians appropriately described involving parents, seeking
    advice from supervisors and group forums within the service and also involvement of the service in setting up sounding board sessions with experts on consent. There was concern about delays in developing more information tools, such as leaflets for certain groups. It
    was acknowledged that this was an area where best practice was still developing and that the service was playing its part in the development of best practice procedures.

24. In order to protect a framework of neutrality which encourages exploration I recommend that any affiliations or associations by GIDS staff with any external organisations or lobbies need to be transparently declared and should prompt questions of conflict-of-interest.

"A particular issue that emerged for the trust and clinical staff within the service has been
the pressure from strongly held views by various pressure groups, namely the trans-
affirmative and trans-critical lobbies. This continual interest, critical scrutiny and often
very strongly held opinions has created an atmosphere of significant persecution for staff
and the need to repeatedly address some of the issues emerging from groups having
definite agendas. At the same time, it is worth acknowledging that some of these views
and extremes of opinion can be reflected within the staff group."

I'm glad they have actually published the report.

I'm confused over the consent bit - they got consent from parents but not the child or from all involved when they went to an endocrine clinic?

I read it as they were unsure if those consenting understood what they have consented to in the long term, eg infertility

"90. In order to protect a framework of neutrality which encourages exploration I recommend that any affiliations or associations by GIDS staff with any external organisations or lobbies need to be transparently declared and should prompt questions of conflict-of-interest".

That's interesting. They seem to acknowledge that some staff have affiliations and associations with lobby groups.

So they are only now asking staff to declare these links.

Astonishing that staff are allowed to have these links in the first place and doubly astonishing that, to date, they have been allowed to hide these links.

And that never, in decades of treating patients, has the Tavi even considered that staff links with lobby groups might be problematic in a clinical setting.

I'll bump this thread as the review does appear to be a small step forward in the protection of children who believe they are trans.

My understanding is that a revised treatment protocol will be written with more emphasis on:

Adequate exploration of sexuality.
Time and space given to complex cases (ASD etc)
Exploration of the causes of a young persons GD.
Time spent evaluating consent.
Safeguarding.

And all practitioners must operate within these new guidelines.

I wasn't reassured by the report - it seemed to minimise quite a lot.

I just searched twitter to see who had picked up on the report and found this thread had similar concerns

twitter.com/porridgehead2/status/1113518259544969216

...pressure from strongly held views by various pressure groups, namely the trans-
affirmative and trans-critical lobbies.

Any idea who the trans-critical lobbies putting pressure directly on GIDS are?

The church maybe? I'm not too sure who else would have the clout to apply pressure?

I guessed it was transgendertrend, where pressure actually meant scrutiny, but it is only a guess

I wasn't reassured by the report - it seemed to minimise quite a lot.

Yes ideally I would have liked it to have gone further but surely it's an acknowledgement of the concerns we have and it seems to be applying the brakes a little. I don't know if you've seen this but the report has not been well received by the trans affirmative lobby.

twitter.com/Tara_Hewitt/status/1113483056852144128

Gosh that thread really highlights the need for proper assessments and a need for evidence-based procedures.

How can wanting to provide psychological support be seen as conversion therapy? The effects of puberty blockers and surgery are so monumental - even if you think children can consent to this (which I don't) how on earth do you think it's a problem for them to make sure it's not sexuality or trauma that's driving their decisions?