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.”

The deadline is tomorrow, not Monday.

Just done it. Didn't manage as much detail as I'd have liked but the beat is the enemy of the good (as my mum always used to say). For me the key is to put disagree for Q.4 and call for more robust research based guidance on social transition for adolescents. (Ie no social transition unless and until longitudinal studies suggest this is ever beneficial).

Responded just via radio buttons and with TT’s questions from their blog at the end.

Closes today! Midnight, I think

Done. Interesting to see that they are proposing initiating safeguarding processes if a young person accesses hormones/blockers from an unregulated source.

Just bumping because the deadline is today Sunday 4th. (I got it wrong earlier in the thread).
Well done everyone.

Just completed mine. No time for deadline so assumme it is 1159pm? I used our Duty and Transgender Trend to help me.

Gosh, thank you, almost missed it.

Yes I think deadline is midnight @FemaleAndLearning

Also done. Have been putting it off but it was much quicker than expected.

Bump - deadline is midnight tonight (4th Dec)

Done. Feeling emotional and tired - it's all so bloody awful!

Phew, just done with reference to TT and Sex matters. Thanks for the kick up the arse to get this in (and good call the poster who said 'good is the enemy of done' - I may be paraphrasing - but it helped me stop on my inner perfectionist and get a few key points down).

Link to respond: www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/

www.transgendertrend.com/nhs-interim-service-specification-consultation/

Just seen that the Cass Review responded to the consultation:

twitter.com/thecassreview/status/1599763092476661760?s=46&t=XO8toVoadSdZWwItcC8z2A

cass.independent-review.uk/wp-content/uploads/2022/12/Cass-Review-Consultation-Response-FINAL-SUBMSSION.pdf

Thanks, Resister.

The whole 5 pp letter is too long to post in - a few excerpts:

The introduction of medical oversight is a welcome change, which would bring the service in line with other multi-disciplinary models of care across paediatric medicine, where challenging decisions about life-changing interventions are made; this is more consistent with some international approaches for this group of children and young people.
We also welcome the recognition that this is a heterogenous group and that not all children and young people will want or require a medical pathway, and that the service needs to include the appropriate skill mix to support both those individuals who do require medical intervention and those who do not.

The new service needs to ensure children and young people receive support much earlier in the pathway to reduce the risk of diagnostic overshadowing.

Building a better understanding of the needs of gender questioning children and young people across the wider workforce is the only way to improve support for the increasing numbers of children and young people seeking help, whilst also ensuring that the smaller number who are most in need of specialist services are able to access them in a timely way.

Social transition

When there is clinical involvement in the decision-making process, it is important that the risks and benefits of social transition as a planned intervention, sometimes as part of a medical care pathway, are discussed carefully, referencing best available evidence.

Research

further work is required if the short- medium- and longer-term impacts of all clinical interventions are to be understood, starting most immediately with the effects of puberty blockers on neurocognitive and psychosexual development, gender maturation and executive function.

un-regulated sources

no clinician should prescribe outside their competence, nor should GPs
be expected to enter into a shared care arrangement with a private provider acting outside of NHS guidance.

Sorry, all of that should be in quote marks.

The social transition part is definitely worth highlighting though:

"Through our discussions with stakeholders, it is clear that references to social transition are a cause of concern. We acknowledge that the interim service specification describes how the specialist services will operate and is not a statement about wider society. This is an important distinction.
Social transition is a very broad term. Gender stereotypes are unhelpful, and in some instances push young people into feeling they have to present a rigid binary male or female appearance; changes in hairstyle and/or clothing may be part of a more fluid or non-gender conforming expression of identity.
At the point of presentation to NHS services, some children and young people will have socially transitioned already, while others may be considering this. When there is clinical involvement in the decision-making process, it is important that the risks and benefits of social transition as a planned intervention, sometimes as part of a medical care pathway, are discussed carefully, referencing best available evidence. Decisions will be individual, and the agency to make the decision will ultimately rest with the young person, along with their family/carers. The role of the professional is to facilitate parents/carers, children and young people to engage in an in-depth process of discussion and thinking around this decision, including considering how this will fit within the broader holistic approach to addressing the

young person’s needs, how the process might proceed, how they will be supported and how they will be given opportunities to reflect on their lived experience.
Although we agree that pre-pubertal children have different needs to older adolescents, some of the distinctions between these two groups, which are set out in the section on social transition in the service specification, will need to be further informed by the evolving evidence base. At this stage it is important to specify that different groups will need different pathways, but the detail of the clinical approach within these pathways will need to develop collaboratively as the services evolve and the Review progresses."

It really does beggar belief that a multi disciplinary team providing unevidenced treatments involving sterilizing healthy children with experimental drugs did not previously have to be led by a medical doctor.

And also that patients have not always been discouraged in the strongest terms from sourcing their own sex hormone supplements.

Just let that sit for a moment.

How did we get here? Just WTAF? Where was the good governance? Those poor children - who was protecting them?

The social transistion points are also incredibly important to consider, as is the equality impact assessment - other children in the class/school also need to be considered.

Let's hope good sense will finally prevail....🤞

Good sense might be here...

Online Safety Bill - new clause on encouraging or assisting self-harm
www.mumsnet.com/Talk/womens_rights/4692450-online-safety-bill-new-clause-on-encouraging-or-assisting-self-harm