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

No patient outcome data.

None. NONE.

How long has this racket been going on for?

aside from waiting times data “there’s virtually no other data” available from the adult clinics, including to show patient outcomes and “minimal clinical audit”.

No interest in patient outcome; minimal auditing. An open invite to dodgy docs and zealous activists. Is there any other branch of medicine this unprofessional?

I'm absolutely horrified (though sadly not surprised given what we already knew) at the lack of well everything - no data, no follow up, no patient safety considerations, no evidence - I mean there's fuck all!

no patient should be treated like this, I mean my god I'd seen the WPATH "we were winging it" stuff but fucking hell

did everyone involved forget every bit of medical training they'd had????

WTAF

No follow up and no data.

This is not unexpected considering the lack of tracking from the Tavistock, but this is actually pretty horrendous.

sadly I suspect there will be next to no coverage of this in the media and NHS England and the dept of health and social care will completely ignore it

They don't even record the sex of the patients consistently.

16. The GDCs have reported that the referred population has shifted from predominantly birth-registered males to a more even ratio of birth-registered females and birth-registered males. The review has not been able to obtain exact numbers, as not all GDCs report sex assigned at birth, but instead may report patient-reported gender (female, male, non-binary, other) and “not known”.

Yes, the lack of outcome data is pretty appalling.

Everything I have seen from TRAs and the trans lobby in relation to this review is concern that it will put up barriers to accessing hormones and medical procedures. But don't they want to know that there is good evidence for medical interventions? If I was going to have major surgery, I'd want to know what the likely outcomes are.

My understanding is that they have been sitting on this report for a while. I'm not sure why.

These points jumped out at me

13. The adult GDCs report that there have been significant changes in the population being referred to them. The population has shifted from an older cohort to a predominantly younger age group. The majority (57%) of referrals are now 18 to 25 years old.

17. The GDCs have informed the review that the new, younger cohort of patients has a higher proportion of additional neurodevelopmental conditions, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), and a broader range of biopsychosocial issues, such as mental health conditions, trauma or abuse during childhood, compared to patients referred in the past.

18. This reported shift has not been systematically evidenced due to a lack of data stratifying the presenting population by additional needs and conditions; however, some GDC clinicians report that 30 to 50% of their patients may present with additional conditions

So they could release it on a wet afternoon in December less than a week before Christmas so no one would notice?? Perish the thought that that would be in any way deliberate

And again no data

98. The review heard that, following assessment and treatment, some patients express regret or dissatisfaction; a smaller number choose to discontinue or reverse their gender transition. Some later decide to retransition.

99. The number of patients who express some form of regret, dissatisfaction or choose to detransition is unknown due to the absence of GDC outcomes data.

Because data and science obstruct fairytales.

Those things really do force material reality to the fore.

So children will be put on a "pathway" to these utterly inadequate adult clinics

Yep!

Completely damning:
"The absence of any patient outcomes data, alongside limited and inconsistent quality data reporting, and minimal clinical audit makes it impossible to properly understand patient outcomes and the safety of these services. These gaps place these clinics outside standard NHS quality assurance expectations.
In addition, existing patient demographic data and clinic feedback indicate that there has been a shift in patient demographics in recent years to a younger cohort with reported additional conditions. Yet, this has not always been met with corresponding changes in how some clinics identify and address patients’ potential additional biopsychosocial needs".

What a charade! To know that this cohort are are no longer the men with a fetish but mentally vulnerable young people who've been gaslit into believing a sex change will cure their considerable mental health issues. And they end up "in the care" of NHS staff providing services that don't don't "meet the service specification, nor does it meet the needs of the current patient cohort"

And the NHS has presided over and funded all this for years.

13. The adult GDCs report that there have been significant changes in the population being referred to them. The population has shifted from an older cohort to a predominantly younger age group. The majority (57%) of referrals are now 18 to 25 years old

And a further 28% are aged 25-34.

Given that the original cohort was older males, and now 85% of them are younger people of both sexes (although due to their inability to record sex they don't know the actual proportions), you'd think this would give them pause for thought. But apparently not.

Maybe they were waiting for Wes Streeting's defence of the new trial in the HoC yesterday before releasing it.

17. The GDCs have informed the review that the new, younger cohort of patients has a higher proportion of additional neurodevelopmental conditions, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), and a broader range of biopsychosocial issues, such as mental health conditions, trauma or abuse during childhood, compared to patients referred in the past.

18. This reported shift has not been systematically evidenced due to a lack of data stratifying the presenting population by additional needs and conditions; however, some GDC clinicians report that 30 to 50% of their patients may present with additional conditions

So they've noticed that these patients have these 'additional conditions', but they haven't thought to investigate why these patients have suddenly started being referred to these clinics, or whether this is the best treatment for them.

Sex Matters take https://sex-matters.org/posts/updates/the-levy-review-of-adult-gender-services/

Just catching up with this. The transes seem to be cautiously accepting/optimistic about it.

What they don't realise, and I see immediately, is that now they will be documented. And other, possibly contributing factors, will be taken into account. And outcomes can therefore be measured.

So, transes: if you don't want to DIY, or go private, you're going on a centralised list.

I don't think that has occurred to them yet.

They conclude that what's happening is the "speeding up the pipeline of state-sponsored conversion therapy".

Shameful.

Agree.

And I can see why they want it to die in the long grass with the Puberty Blockers trial and Children's services feeding into it, and another 'Conversion Therapy' ban Bill on the table.

What a mess.

Where have all the checks and balances gone.

Pathway from Classroom to the Clinic to the Crematorium (assisted dying - see Canada)

It’s more of a stairway to heaven.

Is this the data that Cass wanted but clinics refused to supply?

is this the ‘data’ that has been suggested should be looked at to determine the success of outcomes of ‘gender affirming care’ before starting the puberty blockers trial? I could barely write the word care in that sentence - can’t believe quite how much of a shit show this is, Everytime I think it can’t get worse and there must be some sort of assessment it does, I don’t know why I’m still surprised by this. I can’t believe how much these young people have been so let down.