NHS England and NHS Improvement - Puberty blockers update

[ItsAllGoingToBeFine]

www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/update-following-recent-court-rulings-on-puberty-blockers-and-consent/

Summary: children already on PBs can continue, with parental consent.

New patients currently require court order to start, but this will be replaced by a "decision group" of experts which will examine the decision making processes.

How do they get to overrule the court of protection who say they are needed to make a decision on behalf of a child? The NHS has no capacity to make decisions for others.

Interesting inclusion:

"The judgment of the Administrative Court, accepted by the Family Division, was that the use of puberty blockers to treat gender dysphoria in children should be considered experimental given the limited evidence of efficacy or long-term effects of the treatment."

@Tibtom

How do they get to overrule the court of protection who say they are needed to make a decision on behalf of a child? The NHS has no capacity to make decisions for others.

The court said children could not consent. The question of parental consent was not considered as GIDS didn't use that.

So they are going to use parental consent, which the court did not rule on.

New patients currently require court order to start, but this will be replaced by a "decision group" of experts
I dread to think exactly who will be on this "decision group".

The review group talks about good decision making but still ignores the central point of consent unless they switch to parental consent which it looks like they are despite telling the Bell court they never would.

So rather than going to court for decisions, GIDS will now take the decision with parental consent (which they stated they wouldn’t do) and then the process will be assessed by a review group.

Unless the review group is wholly chosen from parties which are not influenced by GIDS and their policies or the lobby groups that have influenced GIDS, then I have to wonder whether it will provide any useful improvement to the safeguarding procedures that were so noteably absent when examined in court.

It's not reasonable for every decision to be referred to court though and the proposed process includes MH professionals and will be a lot more open than previous practice.

As an interim measure, and in direct response to the Court’s suggestion that additional safeguards may be warranted, a new independent multidisciplinary professional review group will be established to confirm decision-making has followed a robust process.

This group will be comprised of health and care professionals with expertise in child development, neurodevelopment and mental health, assessing capacity and consent, and safeguarding processes. The review group will ensure:

the Tavistock’s GIDS has carried out an enhanced clinical review of each patient;
there has been a robust process for providing parental consent and child assent;
adequate information, including on the risks and benefits of puberty blockers and on the limited available evidence such that the court has described the treatment as ‘experimental’, has been provided to both patient and parent(s);
the clinical process for forming a prescribing recommendation followed good practice guidelines;
any relevant needs of the patient, and what this may mean for their wider healthcare, has been fully explored.

I think we can assume this will be monitored very carefully with outcomes tracked too.

As an interim measure, and in direct response to the Court’s suggestion that additional safeguards may be warranted, a new independent multidisciplinary professional review group will be established to confirm decision-making has followed a robust process.

This group will be comprised of health and care professionals with expertise in child development, neurodevelopment and mental health, assessing capacity and consent, and safeguarding processes.

This is a much needed interim measure in order to Safeguard the children previously seen only by GIDS specialists. Providing of course these experts come from without a gender ideology framework and are free to apply their professional expertise in making a holistic assessment.

This is a much needed interim measure in order to Safeguard the children previously seen only by GIDS specialists. Providing of course these experts come from without a gender ideology framework and are free to apply their professional expertise in making a holistic assessment.

The make-up of the group and who has voting rights is all important.

The make-up of the group and who has voting rights is all important.

This ^^

The members of the group will immediately find themselves the focus of intense lobbying and threats and criticisms it they disagree with TRAs. This is also likely to affect who would be happy to join.

The members of the group will immediately find themselves the focus of intense lobbying and threats and criticisms it they disagree with TRAs. This is also likely to affect who would be happy to join.

I agree with you about pressure from TRAs but will also now be also be more pressure to be cautious without good reason to intervene. Not to mention scrutiny which was missing previously and legal weight.

The MD team will be people involved in the young persons care, I don't read it as being a separate panel.

Not 'independent' at all then?

I read it as independent. Given the bad press, I imagine the NHS is going to use the term 'robust' when looking at the steps they take. At least I bloody well hope they will

a new independent multidisciplinary professional review group will be established to confirm decision-making has followed a robust process.

The MDT is a well established process for reviewing decisions in cancer care.

If the group are sensible they will be as independent as NICE

I still don’t understand how parents can give consent to healthcare that has no evidence base on the say so of a child who has been deemed by the high court to lack sufficient insight to consent.

The children who have been prescribed 'puberty blockers' are vulnerable and need continued healthcare and support.

So would I be correct to say that they are 'getting around' the problem of potentially prescribing very damaging medication to children which the court ruled they could not do and which could lead to them being sued by asking parents to sign on the dotted line? Thus they are absolving themselves of any responsibility?

It's a bit like the Gillick competence test in that, the GP will decide if the child is competent enough however it is the parents that have to pick up the pieces if things go wrong. In this case they could/will go very wrong.

How are most parents qualified to do this? The pressure will be from the child and the TRA groups to go for blockers, it will take a very strong parent to say 'no' and I assume both parents will be asked?

The management of individual children's care will no doubt alongside the wider context of NHS practices and potential liability issues.

Sonia Appleby's case (Children's Safeguarding Lead) against the Tavistock & Portman Trust will be significant.

apologies, should read
The management of individual children's care will no doubt evolve alongside the wider context of examination of NHS practices and potential liability issues.

The pressure will be from the child and the TRA groups to go for blockers, it will take a very strong parent to say 'no' and I assume both parents will be asked?

Unfortunately, from my experience of families where the parents are split on this issue, the relationship is likely to break down. If the relationship were lead to separation or divorce, I should think a child would be persuaded to refuse to be placed or allocated time with the non-consenting parent for 'safety' (given the current rhetoric). In such cases, I've no idea if the parents would have a relative weighting in the medical decisions or if it would become a legal matter.

If the group are sensible they will be as independent as NICE

The appointment of the members and apportioning of voting rights would be interested. In this context it might be useful to reflect upon NICE's current progress of Managed Access Oversight Committees or the groups that guide Managed Access Arrangements.

Good to hear that parents will finally have the right to protect their children from harmful medical intervention though.

@WallaceinAnderland

Good to hear that parents will finally have the right to protect their children from harmful medical intervention though.

Yes, after all the pushing, I'm hoping this ''parents know best'' talk also applies to the parents who don't want to consent to their children being put on experimental drugs?

As a parent, I think that would give me the confidence to say to the child and professionals that I was not comfortable making such a decision for my child and would rather wait until they were 18 and able to make decisions for themselves. That would completely obsolete the use of puberty blockers and the potential harm in future years.