Doesn't this BBC article about Tavistock mis somethingmis something Out?

[JellySlice]

crisis at the Tavistock's child gender clinic www.bbc.co.uk/news/uk-56539466

Apparently the problem at the Tavi is that waiting times are too long.

Link not working.

www.bbc.co.uk/news/uk-56539466

BBC News - The crisis at the Tavistock's child gender clinic

www.bbc.co.uk/news/uk-56539466

The new scores did not impact on numbers. Referrals - which could come from GPs, schools, social workers, and even some charities and youth groups - exploded in 2015-16 at their fastest rate yet: more than doubling from the previous year to 1,419.

Which charities?

This for me is the biggest problem. If many of these children had been seen by experienced paediatricians, mental health workers or healthcare professionals without a gender-affirming bias, the situation would be a lot different. Instead, a school or charity hears “gender! Trans!” and the children are set on a pathway from which many can’t return.

You should only be able to be referred to a gender clinic if an experienced child psychiatrist or paediatrician thinks it’s the best option never.

If it misses something out, it will likely be because it's in one of Hannah Barnes' many other Tavistock reports.

Follow the links to previous reports in the article.

Her Newsnight team has been doing sterling work here, and is up for an award for it.

Ah, had to go back and check the award - they were nominated, but didn't win. Sky's Covid coverage beat them.

Neutral article which is good.
Uses the phrase 'perceived' mismatch between biological sex and gender identity.
Missed out-
The gigantic elephants in the room which are the KB case and why so many drs left &/or felt unable to speak out.
Also, apparently it's autism awareness week (I was unaware too until Twitter today!) and it's a shame that it doesn't talk about autism (particularly amongst girls) in the list of accompanying 'issues')

I dunno - I think that article is fairly damning. They had a report in 2015 which: "It argued the service was "facing a crisis of capacity" to deal with an ever-increasing demand and strikingly it should "take the courageous and realistic action of capping the numbers of referrals immediately".

And they did nothing. They continued to take referrals from inappropriate sources - charities and youth groups, schools and social workers - none of whom have any medical or diagnostic training whatsoever. And because numbers exploded from 97 to over 1,500 in 5 years "We do not have the resources to offer therapy,".

Now there are nearly 5,000 children waiting 2 years for a service which does not have the resources to offer therapy and which can no longer prescribe puberty blockers to new patients. New patients who have been told that they've been born in the wrong body and that they will be suicidal if they don't have immediate treatment.

A monster has been created and our children are just cannon fodder to feed it.

A monster has been created and our children are just cannon fodder to feed it.

< nods sagely >

It is extremely neutral which is helpful in reaching wider audiences. But I think it's a shame it doesn't mention the staff's own concerns about gay and autistic children being referred, as these concerns are now on record I think?

But I think it's a shame it doesn't mention the staff's own concerns about gay and autistic children being referred, as these concerns are now on record I think?

Well, the same reporters have covered it before, and at least some of those articles+programmes are linked from that one.

But yes, maybe it's time they did another refresher covering the entire topic.

GIDS statement "Our Gender Identity Development Service
4 November 2018
(extract)
The GIDS was founded in 1989 and is one of the longest standing services for gender diverse children and young people in the world. Domenico Di Ceglie, who founded the service, wrote a set of therapeutic aims which we still abide by today. This includes the unconditional acceptance and respect for young people’s gender identity. We do not therefore take a view regarding the outcome of an individual’s gender identity development: rather, our focus is to provide a space for exploration of gender, to ameliorate any negative impacts on general development and to work with young people to think through all the options open to them. These principles remain central to the delivery of the service." (continues)
tavistockandportman.nhs.uk/about-us/news/stories/our-gender-identity-development-service/

Dominico Di Ceglie paper, 'Castaway's Corner' published Clin Child Psychol Psychiatry 2002 7: 487 describes the setting up of Tavistock GIDS service for children and Mermaids parent support group and is worth reading.

Di Ceglie wrote the service specifications of GIDS which they still follow. He also remains a member of the board there.

Within the principles that he asserted is the belief that children have a 'gender identity'.

The 'first case' which piqued his interest was a distressed teenage girl. Whether she had undiagnosed ASD / ADHD, had been subjected to abuse or was a lesbian no-one will know. Note how he took her case despite having no relevant experience or knowledge because he thought it would be good training opportunity and it piqued his curiosity.
www.researchgate.net/publication/270564195_Castaway%27s_Corner

One of Di Ceglie's next patients (a young boy) would likely have being more appropriately supported by an experienced Child Protection Social Worker or play therapist

(extract)
"I used to see this 7-year-old boy after school as my last case. He made few demands of me as his therapist. This seemed to be the perfect patient to have at the end of a hard day. As soon as he walked in the room he would start to play with the dolls’ house, placing all the dolls, which I had provided, in the little rooms apparently totally ignoring me and tidying up everything near the end of the session. The problem started when I asked him what he was playing. He came up with very elaborate fantasies on how all the children in the house were going to be killed by various means, including the use of poisonous gas released by a cylinder. I was shocked to find out that so much was going on in his mind in spite of the mild appearances of his behaviour. Within a Kleinian perspective (Klein, 1975), if the dolls’ house represented the body of the mother or his relationship with the mother there was very little of a benevolent nature going on there. So much for the ‘blissful’ relationship!" (continues)

"During the life of the service, staff and users have contributed creatively to its development. For instance, a mother of a child with gender identity disorders involved in a dispute over contact with her ex-partner, asked me during a court break if she could meet other parents facing similar issues. This was the start of a new development – the running of a group for parents of children with gender problems. This group became an important feature of our service and then led to the formation of a self-help organization called ‘Mermaids’. Mermaids had been the focus of discussion in one of the parents’ groups in an attempt to understand the fascination that some children have for these mythical creatures. ‘Mermaids’ is a complementary organization to our service, which offers the kind of help and support that we, as professionals, cannot. Their social activities and networks provide, in my view, a space within society in which children and teenagers with unusual gender development can feel accepted. Their social isolation is reduced and they can start to feel part of a community"

Bernadette Wren: on change
Interview by Glenn Gossling 2020, for In Mind magazine
(extract)
Bernadette Wren is a Consultant Clinical Psychologist and Systemic Family Therapist who worked at the Tavi for twenty five years as a clinician, trainer, supervisor and head of the Psychology discipline. In her time at the Tavi she was deeply involved with the GIDS team, working there initially in 1997-2000 and then from 2011 until her retirement in 2020. In that time she has seen significant change, but much continuity too, in the challenges to that service. “At the time I went back, even though the team was tiny, there were many differences between the clinicians in how they conceptualised the clinical and theoretical issues. Real tensions existed.” (continues)

"She joined GIDS in 1997 after qualifying at the Tavi as a family therapist on M6. She says, “After I qualified, there was a very part-time job going in the Gender Identity Service, then housed in a tiny office at the Portman. I think I was the fourth staff member. At the time it really wasn’t comfortable being at the Portman; we felt very marginalised.” In fact one of the early, very public, critiques of gender clinics came from within the Portman in 2002, when a group of adult clinicians wrote to the Telegraph strongly asserting the ‘delusional’ nature of transgender identities.

Bernadette takes a thoughtful view of this, saying, “The Portman then, as now, would have been the clinic taking on as adult patients people who were among the small number voicing regret for the surgeries they had undergone. But clinicians tended to build their whole understanding of trans identities on working with that group of patients. In GIDS, meeting very young people, we saw things differently.”

In 1995 Domenico de Ceglie set out the therapeutic aims and values for GIDS by which the service still abides. These include the ‘unconditional acceptance and respect’ for young people’s expression of their gender identity. “Those therapeutic aims still represent the core values of the service – they’re Domenico’s lasting legacy,” says Bernadette. “He grasped that if you want to have a genuine engagement with young people you have to take very seriously what they feel and what they say.” And she adds: “if you want to know how GIDS still operates, read Domenico’s aims.” (continues)
100years.tavistockandportman.nhs.uk/bernadette-wren-on-change/?v=79cba1185463

Mmn. I just read the article and came here to see if it had been noticed. This looks to me - especially considering it's been released by the BBC - like the beginnings of the arse covering narrative. And I have some sympathy for them. But it looks like they're going to go with poorly advised, should have stopped referrals and thought/planned better but kept trying to meet needs as best they could, and that's why we have situations like the Bell case now.

And I have a lot of sympathy with them. The report made clear the kind of pressure and difficulty holding boundaries that staff were under. The responsibility is on an NHS and system that let it happen despite repeated resignations, whistleblowing and reports, and some of that is due to the political hot potato it has been allowed to become.

My issue with this article is that unless the reader has been following this issue, what they take way from the article is how awful it must be for the poor little children to have to wait so long for treatment. Not that the 'treatment' is flawed and highly contentious.

It's like articles that refer to transwomen, without any indication that the word does not refer to females - which the vast majority of uninformed readers believe it does.

Youth groups could refer? I didn't know that.

Like that lgbtq youth group in Coventry, prism, for who AC used to volunteer for?

🤔

Youth groups could refer? I didn't know that.

Like that lgbtq youth group in Coventry, prism, for who AC used to volunteer for?

Youth Groups, schools, colleges, voluntary organisations such as Mermaids not only can refer but GIDS as part of its NHS service specification GIDS has responsibility/objectives for informing/guiding those community services as 'the experts' in children's 'gender identities'.

See p12 onwards
www.england.nhs.uk/wp-content/uploads/2017/04/gender-development-service-children-adolescents.pdf

Extract (p16)
"Referrals
3.2.2 Referring professionals will be encouraged to discuss the referral with the family/ carer and seek their agreement. The Service will only accept referrals for children and adolescents with features of GD which are consistent with the current diagnostic criteria as defined in DSM-5.
Referrals can be made by staff in health and social services, schools, colleges of further education and by people in voluntary organisations who may have concerns about a young person’s gender identity development and associated difficulties. "

www.england.nhs.uk/publication/gender-identity-development-service-for-children-and-adolescent-service-specification/

Referrals can be made by staff in health and social services, schools, colleges of further education and by people in voluntary organisations who may have concerns about a young person’s gender identity development and associated difficulties.

And schools are being told by groups such as Stonewall that they don't have to inform parents if their child identifies as transgender. So could a child could be referred to GIDS by the school without the parents' knowledge?

And schools are being told by groups such as Stonewall that they don't have to inform parents if their child identifies as transgender. So could a child could be referred to GIDS by the school without the parents' knowledge?

Referred to and embedded in the OP article are Tavistock & Portman July 2015 Board of Directors minutes,

(extract)
"Just a month later, the July 2015 minutes record that GIDS director Polly Carmichael acknowledged the service had reached a point where it "would have to say enough" and she was working on how to convey this to NHS England.

The Trust's then medical director also conceded there was a sense of "escalating risk", not just from work pressure but also in "the number of safeguarding and risk concerns being brought to him for advice".

www.bbc.com/news/uk-56539466

(extract)
"17 Patient Story - GIDS
Ms Greatley welcomed two young people from the GIDS service, Ms H and Mr I, and the board introduced themselves.
Mr I explained that his route to GIDS had been straightforward, with a
referral in August 2014 and then initial assessment in November. These had led to a referral to UCLH and the prescription of hormone blockers. Ms H’s journey had not been as smooth, as her GP hadn’t known how to respond to her, and when she did get referred to CAMHS there had been a long delay with multiple assessments before she was referred on. However, once at the Tavistock things had been clearer and more structured.
Mr I commented that it was easy to find the centre, the receptionist were welcoming, and the clinicians were really nice and made it clear how the visits would work. Ms H agreed that it was a good place to visit, and added that having two clinicians made sessions feel more open and less like interviews. Mr I added that two clinicians meant that the family could be supported too, so they could speak to clinicians separately before coming back together.

Dr Harris asked what their mothers might say about the experience of
visiting the Tavistock. Ms H said that her mother had found it helpful, and before visiting they had argued a lot, but the sessions had allowed them to talk about things which had improved their relationship.
Ms Gizbert asked Mr I about the wait before he could come to the Tavistock, and how that had felt. Mr I said that it felt long at the time, and he knew it could have been done faster through school but he hadn’t wanted to involve his parents. Looking back on it though, it was ok. Dr McPherson asked how it had been with school, and Ms H said that she had come out first at school and they had agreed she could wear the female uniform, but they had offered no counselling, referral or advice.
Mr Jenkins explained that he attended the GIDS summer event, and
wondered if there was more the Trust could do to raise awareness.
Ms H said that having stories about what it was like to come to GIDS on the website would be good, with details of what the process was like in practice, as she had assumed that all she would need to do was visit the GP to be prescribed hormones. Mr I added that stories from young people would be better than ones from adults or clinicians" (continues)

As 'Mr I' and 'Ms H' are both described as current patients/service users of GIDS they are children (under 18) and therefore legally the opposite sex to that usually associated with the titles Mr/Ms

Thanks R0, you can see why parents are concerned about the brushing aside if normal safeguarding practises when it comes to gender identity.

WarriorN Sonia Appleby, the Children's Safeguarding lead at Tavistock & Portman, has instigated a case against the trust based on what she identifies as 'Safeguarding concerns at GIDS'

Background by Appleby:
"I am a qualified social worker (1981); adult psychoanalytic psychotherapist (I992); MSc. in health psychology, (research) and MBA. I have a long career safeguarding and protecting children in social care, health and as a children’s guardian in public and private proceedings.

I am currently the Named Professional for Safeguarding Children and the Safeguarding Children Lead at the Tavistock and Portman NHS Foundation Trust. I am therefore still employed by the Trust against which I am bringing my claim.

What is Safeguarding?

In all NHS trusts and organisations there are professionals such as myself, who work with other internal departments and external agencies to ensure there are 'root and branch' systems to keep patients and service users safe. This means responding to patient/service users' personal experiences, also including their environmental, familial, community/peer circumstances and sometimes any of the aforementioned domains could require the intervention of other professionals in different agencies. Safeguarding children and young people also concerns ensuring there is a sufficiently, healthy culture that does not unwittingly contribute to potential harm regarding the people who use and deliver NHS services.

Safeguarding within the Trust

My primary task is to ensure that clinicians protect their patients/service users from avoidable harm and are also able to recognize and appropriately respond to situations where under 18s are in need of safeguarding. My secondary task is challenge practices which are either harmful or could lead to harm. The Trust is commissioned by NHS England to deliver a National Gender Identity Development Service (GIDS), which provides services for children and adolescents diagnosed with gender dysphoria. The treatments available also include "puberty blockers".

I have sought to ensure the principle of ''safeguarding children and young people'' is upheld whilst service users are being assessed and treated within the GIDS service.

My Claim

I lodged a whistle-blowing claim in November 2019 at the Central London Employment Tribunal. Since then I have made 2 applications to amend my claim as new information came to light.

In my claim, I allege that because I made "protected disclosures" to my line manager regarding concerns raised by GIDS staff ( that the health or safety of patients was being, had been or was likely to be endangered), I was subjected to detriments.

I allege these detriments are:

i) the Tavistock misused it's own procedures to besmirch me and therefore jeopardize the role of safeguarding within the Trust;

ii) there was an unwritten but mandated directive from the Tavistock management that safeguarding concerns should not be brought to my attention despite being the Trust Safeguarding Children Lead;

iii) and, clinicians were discouraged from reporting safeguarding concerns to me.

I also allege various other detriments.

Further to disclosures made to Newsnight by former staff, BBC Newsnight produced a programme focusing on the allegation that the Trust did not want to report any concerns to me. www.bbc.co.uk/news/health-51806962

and you can watch it here

"

Parents, carers and all adults concerned for the Safeguarding of children within UK NHS and private healthcare provision should be very concerned. The implications of the allegations by Sonia Appelby go way beyond this particular paediatric clinic / service as they potentially expose very serious failures of the Child Protection/ Safeguarding framework within health and social care.

[Post edited by MNHQ to remove fundraising link]

I find it shocking that there has just bern a huge court case that doesn't even get mentioned.

Binglebong Which case are you referring to?

you can see why parents are concerned about the brushing aside of normal safeguarding practises when it comes to gender identity.

WarriorN Parents, carers and all adults should be very concerned that standard Safeguarding and Child Protection practises are being disregarded / undermined when it comes to gender identity.

As appears may be the case here, posting an outline of Safeguarding concerns at GIDS by the Tavistock and Portman NHS Trust children's Safeguarding lead has prompted report/s of my post.

When professionals are not only prevented from carrying out Child Protection/ Safeguarding but then prevented from whistleblowing or discussing the prevention of whistleblowing of serious Safeguarding concerns in NHS paediatric healthcare this is likely indicative of systemic Child Protection framework failure.

The possible implications of this are likely to be catastrophic for some children.

Referred to and embedded in the OP article are Tavistock & Portman July 2015 Board of Directors minutes

Link to the minutes:
tavistockandportman.nhs.uk/documents/143/board-papers-2015-07.pdf

I had a look at the minutes from that meeting to see if there was any more information about what these two young people had said, and if there was any more detail about what Mr I said here about referral by the school.

Ms Gizbert asked Mr I about the wait before he could come to the Tavistock, and how that had felt. Mr I said that it felt long at the time, and he knew it could have been done faster through school but he hadn’t wanted to involve his parents.

This implies that the school would have informed the child's parents (as they should), but that in this case the child found another route for referral about which the parents may not have been informed. Although this sentence implies that Mr I's parents were involved:

Mr I added that two clinicians meant that the family could be supported too, so they could speak to clinicians separately before coming back together.

The person who wrote this up also seems to have become a bit confused about who was who, because the last two paragraphs of this section refer to 'Mr H' and 'Ms I' instead of 'Ms H and 'Mr I'.

Ms I added that she appreciated that the Trust was involving her and the other young people in the service, getting their feedback, and listening to their point of view. She added that they had sat on an interview panel that morning, and it was really good to be on the other side of the table for once.

Is it normal for child patients to be on interview panels at NHS trusts?