Public Consultation - Interim Service Spec for Specialist Gender Dysphoria Services for Children/Young People

[rogdmum]

This is what was leaked by Reuters last week and is now live:

www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/

There’s a fair chunk on social transition on pages 15/16:

”Not all adolescents will want or benefit from social transition. The provision of approaches to support social transition may be considered in cases where:
• Gender dysphoria has been diagnosed, is consistent and persistent; AND
• Associated needs and risks have been considered and are being addressed
or supported; AND
• The young person expresses a clear wish to affirm their gender transition and fully understands the implications of affirming a social transition (informed consent); AND
• The proposed clinical approach is necessary for the alleviation, or prevention of, clinically significant distress or impairment in social functioning in the individual.

In these cases the clinical approach will involve a focus on exploring or supporting (as appropriate to the individual) social transition through psychological support and interventions, family work/therapy and guidance for the local professional network”

And what Reuters reported on accessing prescriptions from online/unregulated providers is included (page 16)

”Prescribing from unregulated sources and unregulated providers
Children, young people and their families are strongly discouraged from sourcing GnRHa and masculinising / feminising hormone drugs from unregulated sources or from on-line providers that are not regulated by UK regulatory bodies. In such cases The Service will make the child or young person and their family aware of the risks, contraindications and any irreversible or partly reversible effects of the drugs and will advise the GP to initiate local safeguarding protocols.”

This feels quite promising, it is feeling more balanced and measured.

I think schools are going to really have to backtrack on immediately and unquestioningly supporting social transition, especially behind parents’ backs.

"Not all adolescents will want or benefit from social transition. The provision of approaches to support social transition may be considered in cases where:..."

This is interesting as it specifies adolescents and does not mention children. Can one take from that that they have not considered that parents and primary schools are also facilitating (and in some newsworthy cases, enforcing) the social transition of very young children? Or that they are talking about adolescents only to exclude the idea that you g children may have this done to them?

Or where it has been instigated and encouraged by parents and schools have unquestioningly joined in and encouraged other children in the school to comply with the social transitioning.

Where neurodivergence or early exploration of sexuality are not sensitively explored.

Where things like FII, and other forms of abuse or household issues have not been considered.

There’s a separate bit about pre-adolescents and social transition. I only c&p the adolescent bit

There’s a fair amount to the pre-pubertal children section, but the summary says:

”In summary, for pre-pubertal children the clinical approach and advice applied by The Service will be supportive and non-judgemental, balancing on a case-by-case basis a watchful approach overall with a more individualised approach in cases where the child’s level of global functioning may be maintained or improved through a carefully observed process of exploration of social transition. Medical interventions will not be considered at least until puberty has been reached (Tanner Stage 2)”

Sorry, I went and found it and read it properly!

"In cases where a pre-pubertal child has effected, or is effecting, a social transition (or expresses a wish to effect a social transition) the clinical approach has to be mindful of the risks of an inappropriate gender transition and the difficulties that the child may experience in returning to the original gender role upon entering puberty if thee gender incongruence does not persist into adolescence."

This for me is hugely important.

i am aware of a 'mummy blogger' who has a 'trans child' and seems to have fully (not only socially but very publicly) transitioned their very young child and I find it incredibly disturbing that no professional has stepped in and raised considerations such as these.

Hopefully this document and guidance will come in effect and help children such as these.

Yes schools need to know what they are doing us not neutral and could have an adverse impact.

And with the tightening of prescribing of hormones and moving onto to medical transition from social as puberty hits (rightly imo) social transition in schools will be more problematic as those who have presented and been accepted as the opposite sex will start to have physical signs of puberty and their natal sex. It's actually easy to see that this could increase the sense of dysphoria and associated issues. So by socially transitioning pre puberty you're just kicking the can.

This should have a massive impact across the board (assuming it does not change following the consultation), not just schools. CAMHS, social services etc will be hard pushed to go against it.

It should also stop Mermaids from turning a blind eye to GenderGP endorsements within their parent and youth forums.

Ideally, ScotGov would listen as well, but I suspect they’ll just say as it’s NHS England, it’s nothing to do with them and double down on their affirmation only stance.

Ideally, ScotGov would listen as well, but I suspect they’ll just say as it’s NHS England, it’s nothing to do with them and double down on their affirmation only stance.

That's a really odd attitude. Do they normally view health reports from other countries in this way? Do they think Scottish people and people who live in Scotland are so different from people in the rest of the UK?

It's really important that we make our voices heard. The munchy mums on Twitter are all over this.

Excellent. Have submitted a response.

Do they normally view health reports from other countries in this way? Do they think Scottish people and people who live in Scotland are so different from people in the rest of the UK?

When it suits their politics, yes. The SNP/Green alliance are positioning themselves as oh-so-progressive against fuddy-duddy old England.

The government are busily ignoring the interim Cass report as hard as they can, they are still putting forward a conversion therapy bill that includes transgender, and in the GRC self-id bill they want to lower the age to apply for a GRC to 16.

Scotland let 16 year olds vote in the Independence referendum and now caution and safeguarding are for the birds.

So has anyone fully read and do they have any comments either way? As many gc teachers parents and anyone else should respond in agreement to counter the tra mass response which will not agree with this?
I don't want to fill it in badly as it were but also think individual responses carry more weight than if we do it through an organisation template?

Generally yes, very happy. A few points in my mind: (1) autism leads to specific problems with "watchful waiting" as people with ASCs can react badly to uncertainty and transition may seem less immediately painful (2) what about support for young people who have started medicating illegally and need medical help to stop? (3) broader point from (2) - what about detransition? In theory no-one that young should need it but I wouldn't rely on it. (4) no mention of breast binding - is that a safeguarding issue or not?

The Wobberlies too. And this classic.

I mean, I'm the same. You can't be a medical expert on childbirth unless you're pregnant. I only want an oncologist who is actually having chemo. 🙄

This is so important.
I've been waiting to hear how these clinics are going to support children and what messages this will send to parents and schools.

The message I'm getting here is: Caution.

Which would at least start to shift the narrative from the sparkly rainbow pom poms Be Your Authentic Self where we have been.

Response to this is really important.

I'll be emphasising the need for extreme caution for social transition which places a child's well being on maintaining a fiction which the reality of their body will challenge every day, which is therefore likely to increase dysphoria and lead to body modification rather than acceptance.

It also places a child's wellbeing and sense of self as relying on other people to support this fiction which they will not consistently do.

A child's wellbeing being at the mercy of how others perceive them goes against everything we know about positive mental health.

We need to move away from this concept of social transition altogether. We should never support children to deny reality and ask others to play along.

If anything transition should just mean a change in presentation: Jack is growing his hair long and wearing sparkly hair slides because he likes it. Not because he's a girl.

This is a positive step but there is still a flawed premise even in the consideration of 'social transition.'

The fox killer isn't happy.

He thinks the only treatment there should be for troubled children caught up in the gender madness is sterilisation and mutilation.

twitter.com/JolyonMaugham/status/1583364606755753984?cxt=HHwWgMDS-ZDunvkrAAAA

I am re-reading it but I would urge some caution as it does contain the term "gender identity" a few times. E.g. up front it says:

"The Service will provide multidisciplinary assessment and care to children and young people and their families who will benefit from clinical support around the development of their gender identity, and interventions in response to a diagnosis of gender dysphoria, and consultation and support to local professionals"

And this is at odds with the terminology, it would seem that this should be:

“clinical support around the exploration of their gender incongruence”

as per the Terminology section on p3, Section 6: Population, which says:

"This service specification will refer to gender incongruence and gender dysphoria. The terms are not interchangeable. Gender incongruence is where the individual’s experience of their gender identity does not align with their biological sex. Gender dysphoria is present when the gender incongruence causes clinically significant levels of distress to the individual. Not all individuals with gender incongruence will experience dysphoria"

So why is that so clear up front but then there is seemingly a mix of terms in the rest of the document?

This must not be a Trojan horse for “gender identity”, which of course relies on "development of" type-language. If we have a situation in which "gender identity" becomes the language, it will carry on elsewhere which is what we are seeing with self-ID in wider settings. It was what was in the so-called conversion therapy consultation where, had it gone through, it would have begun getting onto the statute books.

"Gender identity" is also under the "assessments" section e.g.:

"Subjective sense of the child / young person’s identity over time
Their expression of gender identity across different contexts over time and different settings...
Exploration of parent/carer and family views on the child or young person’s gender identity journey and family support"

It is in other places. Each of these needs careful assessment before comments are made on the consultation.

I can't see any definition of 'gender identity' in those documents. We really need a definition of this. What is a 'gender identity' and how can it be objectively assessed or observed? With no definition and no way of objectively assessing an individual's 'gender identity', how do we know that people who say they have a feminine 'gender identity' are all experiencing the same thing?

And in what ways is a 'gender identity' expected to 'align with their biological sex'?

"I hear you're an expert now". Or something along those lines

twitter.com/mermaids_gender/status/1583430712480305153?s=46&t=vXeqZxyGZqPaTdCWWglg7w

"We have seen the consultation published by NHS England yesterday on the interim service specification for the new Early Adopter services, who will deliver gender services for children and young people from Spring 2023. (1/2)

On initial review, many of the proposals are seriously concerning. We will be further analysing the content, and formulating a robust response with views from our service users. (2/2)"

Thanks, OP. Will definitely be filling this in and sharing.

Note his transformation of "trans children" to "trans people" in one swift move. Because if you ignore age, ability to give informed consent and the rights of children to develop free from the attention of adults with an agenda, then you can also ignore the requirement to safeguard children which is terribly helpful for certain predominantly male groups.