NHS review of adult 'gender' services

[ArabellaScott]

https://www.bmj.com/content/386/bmj.q1788

Starts in September. Headed by Dr David Levy.

'NHS England is carrying out a review of adult gender dysphoria clinics with a remit to explore “broad concerns and issues” reported by “concerned clinicians” during the Cass review of gender identity services for under 18s.
Their concerns reflect similar problems found with services for under 18s, including limited time for assessing patients, expectations that hormones would be prescribed, and lax consent procedures.
The review of adult clinics, announced last week, is expected to last two years and will start in September. It will be led by David Levy, medical director for Lancashire and South Cumbria Integrated Care Board, with support from a panel of expert clinicians, patients, and stakeholders, including representatives of the Care Quality Commission, royal colleges, and professional bodies, NHS England announced in a letter to Hilary Cass, chair of the review of gender identity services for under 18s.1

This is long overdue.

Adults asking for hormones just seem to get them and there's no where near enough resources to offer therapy alongside so it's just not an option.

I'm not convinced full side effects are communicated properly either.

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/review-of-adult-gender-dysphoria-services/

'This review will examine the operating procedures in each service; the appropriateness of the service model for the presenting population; areas of concern, and any action being taken to improve quality. It will identify areas for improvement in relation to service quality, good practice that could be shared with other clinics, and any support that should be made available to services to assist improvement.
The key lines of enquiry will be designed in collaboration with current and former patients, clinicians and other key stakeholders.'

'NHS England’s review of adult services will assess not only the quality (i.e. effectiveness, safety, and patient experience) and stability of each service, but also whether the existing service model is still appropriate for the patients it is caring for. The programme of reviews will be led by Dr David Levy, and will carefully consider experiences, feedback and outcomes from clinicians and patients, past and present. The first onsite visits are scheduled to commence in September 2024.'

https://www.england.nhs.uk/long-read/nhs-england-update-on-work-to-transform-gender-identity-services/

I assume detransitioner accounts will also be looked at, as these accounts most often reveal the overwhelmingly affirmative model being pursued by gender cllinicians.

I sure hope they'll be looking closely at why the NHS are still referring and linking to WPATH.

https://ncth.nhs.uk/other-gp-guidance

That page links directly to WPATH's SoC v 8, which includes the section on 'Eunuchs' and links to the Eunuch Archive.

They are beginning to notice that it is going to cost them a fortune in malpractice suits and medical care for survivors.

https://www.telegraph.co.uk/news/2024/04/12/nhs-trangender-doctor-jonathan-arcelus-male-female-genitals/

https://archive.is/23GAr

'Dr Derek Glidden, who, like Prof Arcelus also works at the Nottingham National Centre for Transgender Health and is its clinical director and is NHS England’s gender dysphoria national speciality adviser, was also criticised after <a class="break-all" href="https://archive.is/o/23GAr/www.telegraph.co.uk/news/2024/04/11/top-nhs-adviser-trans-health-failed-cooperate-cass-review/" rel="nofollow" target="_blank">refusing to share data about his patients with the Cass Review'

'a leading NHS doctor, Jonathan Arcelus, a professor in mental health and transgender health at the University of Nottingham, as among those discussing and endorsing controversial procedures which are currently not allowed on the NHS.

Wondering how they will ensure co operation, given so many clinics refused to even respond to Cass.

This will be very interesting, arabella. The adult clinics certainly need to be reviewed.

I look forward to the findings.

What I noticed today was that this has been another impact of the Cass Report. I hope that these reviews that are starting or being asked for bring about positive change.

https://x.com/bernardlane/status/1823548538133029299?s=46&t=HTxp6zCd4GZ2FFv4a-YeQ

Treatment guidelines used by gender clinics in Australian children’s hospitals falsely claim a medical consensus and mislead parents, distressed young people and health professionals in the wider community.

This claim has been put to Australia’s Health Minister Mark Butler by the National Association of Practising Psychiatrists (NAPP), which is calling for an independent federal inquiry, an audit of gender clinic medical records and a centralised registry tracking all minors treated for gender dysphoria.

NAPP president Dr Philip Morris wrote to Mr Butler on August 2, and also sent him a 19-page overview of the gender clinic debate written by Melbourne psychiatrist and researcher Dr Alison Clayton. These two documents went to state and territory health ministers across Australia’s federation on August 12.

This initiative emerged from the NAPP’s July 2 webinar with British paediatrician Dr Hilary Cass on the relevance to Australia of her 2020-24 review of youth dysphoria care.

“While we note that [England’s National Health Service] and the Australian health system are different, the clinical issues regarding gender identity concerns and gender dysphoria in young people are very similar in our two countries,” Dr Morris’s letter to Mr Butler says.

“We consider the general recommendations about the assessment and treatment of youth with gender incongruence and dysphoria by the Cass review are applicable to Australia.”

Good to see.

There's a lot of heat and noise around Cass, but worth considering that outwith political noise, clinicians seem to be quietly accepting and acknowledging her work.

A case in point is the BMA's grand declaration of contesting Cass, followed by many members protesting.

I’ve just clicked on that GP link to WPATH @ArabellaScott and although the link is still there when you click on it there is now an ‘error 404’ message saying the page can’t be found. Is this WPATH deleting things or just my phone being dodgy?

Interestingly there is a 2 page article in this weeks BMJ about the BMA opposing the Cass review with the usual stuff about marginalised people accessing vital healthcare but there is a quote too at the end from Dr Nick Brown, paediatrician and editor in chief of Archives of Diseases In Childhood defending the research methods of the York group and categorically backing up Cass’ findings.

Nothing mentioned about the letter signed against the BMAs decision but I guess it might have gone to print before that came out.

Thanks, Faffer. Yes, the link points to a page that has moved. WPATH did have a lot of technical stuff going on for a while.

It's been archived many times showing that it points to the SoC, regardless!

It will be interesting to see how they measure outcomes. I see a lot of “Black Knight” attitude in the adult medicalised trans population, like saying they’re completely fine despite someone pointing out their arms have been chopped off.

“I have problems with x, y and X but I’m great, honest!”

It will be important to document the actual problems.

And it needs to be longitudinal and look at outcomes years after treatment.

This is the difficulty with assessing outcomes. Where the baseline (albeit falsely) is suicidal anything can be sold as an improvement.

Agree. Taking hormones is exceptionally bad for both short and long term health.
I have a relative who had to take a hormone blocker for 3.5 years for a life threatening condition and it's ruined their health and made my life very miserable too. Also 9+ months later the effects still haven't worn off and it could take years to get back to normal.

Sinead Watson has publicly said that she still has high testosterone levels despite her last testosterone treatment being four years ago.

That should be very concerning for medical staff and for those on the treatment.

Thank heavens for this review. Agree and I hope they look at record keeping and stop funding clinics and practitioners who don't do this well or who refuse to share data.

The BMA has called for a pause in the government’s ban on the prescribing of puberty blockers to children and young people aged under 18 with gender dysphoria, which was upheld in the High Court on 29 July.12
…
At the heart of the dispute is a series of systematic reviews that rigorously examined the robustness of practice and guidelines underpinning the care of young people with gender dysphoria, in particular influential guidelines by the World Professional Association of Transgender Health (WPATH).3
A total of seven papers by the York University systematic review group were published in the Archives of Disease in Childhood in April.4 The papers found that the evidence on the use of puberty blockers and hormones in young people with gender related distress was “wholly inadequate, making it impossible to gauge their effectiveness or their effects on mental and physical health.”5 Nick Brown, editor of the Archives of Diseases in Childhood, told The BMJ, “A common thread in the review findings was the breathtaking dearth of quality evidence to guide care in this vulnerable group of young people.”
Brown is adamant that the York research is robust. “All of the systematic reviews underwent expert, independent peer review, and each was revised accordingly. We were, and remain, entirely confident as to their veracity. Counter to claims to the contrary, rigorous methods were adhered to at every step,” Brown told The BMJ.
Brown continued, “Criticisms of the methodology hold no water. The single search strategy used by the York group is far more yielding than the scattergun approach advocated by those still struggling to come to terms with the findings.”
The Cass review warned that the use of puberty blockers and hormones for patients under the age of 18 relied on “shaky foundations” and associated guidelines were not supported by science.
An NHS spokesperson said, “Dr Cass spent four years gathering evidence for the most comprehensive report of its kind, and her expertise and advice has been invaluable in supporting the NHS to create a fundamentally better and safer service for children and young people.” Its findings have been backed by several academic bodies, including the Royal College of GPs and the Royal College of Psychiatrists.
The BMA’s chair of council, Philip Banfield, said that the ban on puberty blockers was “unsubstantiated” and “discriminatory” and blocked access to healthcare of a “group of important, valued, and unfortunately often victimised people.” Promising that the BMA’s own review would be produced in time to report to the BMA council in January 2025, Banfield said it was “vitally important we take time and care to get this work right.”
He said, “This is a highly specialised area of healthcare for children and young adults with complex needs, and as doctors we want to be sure they get the most appropriate care and support they need.”
An NHS spokesperson said, “We will shortly be publishing our plan to implement the report’s recommendations and findings, which includes setting out scope for further research, so children and young people can receive the best possible care.”

I hope Dr Levy has been well briefed in what to expect.

A FOI has already been lodged, and we can see he is likely to be treated in the same way as Dr Cass.

https://www.whatdotheyknow.com/request/levy_review_of_adult_gdc_service

'On 07/08/2024 NHSE announced they had selected Dr David Levy to conduct a review of the operation and delivery of the adult Gender Dysphoria Clinics.

Please provide the following information;

1. The total number of individuals who were approached for appointment to

chair the review.

1. The number of individuals who were shortlisted for appointment to

chair the review.

1. A copy of any criteria used in making the selection of a chair for the review
2. A copy of the terms of reference for the review, or if a formal ToR is not available any communications with Dr Levy setting out the scope of his review.'

I hope Dr Levy has been well briefed in what to expect.

I admire any clinician who has the personal integrity and courage to take on the responsibility of leading such reviews knowing how much interest and possibly opprobrium they generate.

It’s about time some sense and science is brought to government and the medical profession in Australia. So many lives have been impacted, bodies experimented on, and children (and adults) failed by zealots of GI.

Bring it on - I hope the true horrors of Australia’s ideological capture and the unconscionable actions of those who push GI and affirmation and surgical/hormonal/medical intervention for dysphoric children are laid bare and those responsible held to account for what they have perpetrated.

Agree Spinach.

I think it was a concerning move to move the Sydney clinic from Westmead Children Hospital team. The team there seemed to be much more inclined to keep questioning everything, and writing papers on their findings. Which is what outraged some who were horrified that their children were not just automatically affirmed.

Levy Review now published:

https://www.england.nhs.uk/publication/operational-and-delivery-review-of-nhs-adult-gender-dysphoria-clinics-in-england/

Reported on in the Independent:

https://www.independent.co.uk/news/uk/home-news/nhs-england-wes-streeting-gps-press-association-b2887089.html