GIDS leadership team to be disbanded

[TheFleegleHasLanded]

twitter.com/hannahsbee/status/1353986641136939008?s=21

Crikey. Here's the text:

NEW:Tavistock Gender Identity Development Service (GIDS) Executive - leadership team - to be ‘disbanded’ in response to CQC’s ‘inadequate’ rating of service & decision in Keira Bell judicial review on whether under 16s can consent to treatment with puberty blockers

“In response to the CQC report and the breadth of existing actions flowing from the Judicial Review judgment we are proposing to take immediate action to strengthen management arrangements for the service and increase our clinical and operational capacity to deliver change”

This will see “a new Interim GIDS Management Board, chaired by the Divisional Director for Gender. This will replace existing senior management structures in GIDS and will provide a single point of accountability for both improvement programmes and existing service delivery.”

This board will be accountable to a new ‘GIDS Oversight Committee’ chaired by Tavistock CEO Paul Jenkins.

“A consequence of these arrangements is that the current GIDS Executive team will be disbanded. Its members will have roles in workstreams and projects relevant to their skills and experience... The Service Director will have a place on the GIDS Interim Management Board.”

The Tavistock and Portman Trust also plan to recruit “a range of clinical and operational experts from outside the service, and in most cases from outside the Trust to increase our capacity to manage and deliver change at pace.”

^This current job advert to work in GIDS highlights that job will see applicant offering psychological treatment and therapy “for issues relating to a range of mental health conditions.” m.pulsejobs.com/psychological-therapies/jobs/clinical-psychologist-gender-identity-london/268929/^

^All details are in newly published Board papers found here: tavistockandportman.nhs.uk/about-us/governance/board-of-directors/meetings/^

My first question is - the Keira Bell case. Who was running the defence there? Was it the Tavistock proper, or the GIDS leadership now being chucked out?

The existing structure is being disbanded to be replaced by another structure with what sounds like the same people. It looks like they are going to recruit a psychologist(s) with a wider remit in terms of therapy for a range of mental health conditions (though not entirely sure I agree with that- sounds like an expansion of the Tavi whereas I’d rather children were treated for underlying conditions local first in a non affirmative environment with the Tavi as a last step referral).

I.e. to me it looks like superficial structural changes when a complete overhaul of the process and leadership is needed.

Very interesting - that thread says it all - it is good that there is change but with the same affirm only staff (and Paul Jenkins) involved I wonder what difference it will make to the kids.

As someone on that thread says, the funding should be redirected to CAMHS to address the mental health issues of the children and GIDS should be a very small, ‘last resort’ facility.

Personally I think gender dysphoria in children should be treated as a symptom and all possible causes explored and treated. That should help narrow down the sufferers to the tiny number that will experience dysphoria that persists into adulthood (I don’t understand how clinicians can claim ‘persistence’ over say, two years - that doesn’t seem like a significant enough amount of time to qualify for ‘persistent’) and help prevent the currently unacceptable level of misdiagnosis.

Would there be any other area of medicine where such levels of misdiagnosis resulting in unnecessary medication and surgery were accepted?

The cancer doctor who did that ended up in prison....

Not sure what to think of this. Seems like a step in the right direction.

I remain cautious due to experiencing a number of restructures in local government following from poor inspection outcomes. You can move the people around but the culture doesn't always genuinely change.

I.e. to me it looks like superficial structural changes when a complete overhaul of the process and leadership is needed.

Yes this was my thought. It happens all the time.

Well. That had to be expected. It was the first thing that crossed my mind when the CQC report came out.

I hope that this means vast improvements will be made including a full throttle focus on comprehensive mental health support before any medicalisation for children and young people and a dramatic increase for adults as well.

And a focus on medical records and after the Cass report, maybe working towards some in-depth studies to actually generate the knowledge to develop better treatment plans. And this should include detransitioners.

I only hope that the recruitment is balanced and focuses on people with deep relevant experience in the field and not people who have a bias to push.

Something has to change in that culture but it has to be more than rearranging the jobs structure. The whole premise that it’s a constantly expanding service in response to patient needs must be scrutinised. Agree about GIDS being a service of last resort and CAMHS needing to be far better funded.

Although, reading others reactions, it seems I am overly optimistic. My Pollyanna side on show again.

Yes, unless there is a cultural difference between "Tavistock" and "GIDS" or this really was a different faction gaining control, this might amount to very little. But maybe the judicial review has forced some self-reflection on their procedures, and people with doubts internally are now going to be able to get people to listen.

gardenbird48 - care to fill us in on this Paul Jenkins? I don't recall hearing the name. Polly Carmichael's the most recognised name - director of GIDS. So she's being moved aside?

This "Divisional Director for Gender"? A search for that brings up Alisa Swarbrick. Nothing obviously concerning on that profile - could be a big improvement, if replacing Carmichael, and she can see what's going on and has the courage and backing to stop it.

I guess Polly Carmichael is the "Service Director [who] will have a place on the GIDS Interim Management Board."

I.e. to me it looks like superficial structural changes when a complete overhaul of the process and leadership is needed

I agree and actually thought it was a load of waffle and weasel words.

Surely the whole patient pathway needs to be looked at after the Bell case. GIDS interaction is only part of that pathway. This restructuring mustn’t just be about GIDS working in the same exact way but with different faces in the top jobs. For example, will the trust be reviewing what changes and checks the endocrinologists and surgeons will need to make around consent with their patients, in addition to changes being brought in at GIDS itself? What changes and checks need to be brought in at GP referral stage and CAMHS referral to GIDs level.

The capture is very widespread and it’s never been the case that GIDS were in some way a ‘bad apple’ or the weak link in an otherwise effective and supportive health system for young people in distress focused around gender.

And we’re still not doing enough to help the other young people who don’t have that particular focus to their distress, the whole system needs review and investment for the benefit of young people as a whole.

I'm not convinced this is much more than a few changes to job titles. Still, time will tell.

Hm. Is this the service dissolving itself just to to make it harder for accountability and repercussions in the course of future litigation? Blame-shuffling and track-covering? [cynic]

They need to be employing someone with confidence in record keeping, and v good knowledge of standards and law in medical records, and giving them a senior position and the power to reform how they do this.

I was agog when I read the stuff in the cqc review about their record keeping. Having worked in a field connected to health, much lower risk than what they do with troubled children, it's ridiculous to think they didn't record why they made the clinical decisions they did.

Moving the deckchairs on the Titantic. No one previously involved with GIDS should be involved much less in charge. Paul Jenkins seemed to think the only issue was waiting times FFS. And he'll be heading up this Omni shambles?

If this is the team that decided to appeal the judicial review, could this decision be changed?

Also, if the Tavistock withdrew the appeal, can a third party appeal it?

And can regulators like CQC, who inspect against leadership, be involved in supporting this structural change and maybe even validating it somehow, to make it meaningful?
It feels like a neutral authority figure organisation, with experience of how many other areas of healthcare turn things around, is needed here. Someone external to give outsiders to GIDS confidence in this being more than a reshuffle.. given the long term whistleblowers concerns Nd the Bell case it seems that there are deep seated issues to be examined.

PS, Jenkins moved over from charity management, he isn’t a clinician or a child development professional.

To me, it looks like it was written by Sir Humphery Appelby.

Also once the Cass report emerges, GIDS will need to be able to say more than, we’ve swopped around some job titles.
This is an opportunity for GIDS to really change how they work. I suppose we’ll soon see if they actually want to take it, or what it is they want to do.

This current job advert to work in GIDS highlights that job will see applicant offering psychological treatment and therapy “for issues relating to a range of mental health conditions.”

Will this make any difference if the professional guidance for psychologists remains to affirm the patient's self identification?

The funding for GIDs comes from NHS England and the Specialist Commissioning Group must have approved this plan.

Given the institutional capture at that level and the Group’s refusal to include de-transitioners among the “Stakeholders” on its Advisory Panel, I think this section needs clarification:

”The Tavistock and Portman Trust also plan to recruit “a range of clinical and operational experts from outside the service, and in most cases from outside the Trust to increase our capacity to manage and deliver change at pace.”

Where is the extra funding coming from to pay for these extra posts?

• Is the Trust diverting funding from other services?

• Have the Commissioners allocated extra funding?

• Are charitable bodies chipping in?