Dr Hilary Cass has outlined reported failings in transgender clinics for adults in a letter recently made public.
Writing to NHS England in May, Dr Cass shared concerns raised by a number of clinicians about the “model of care” in several NHS adult Gender Dysphoria Clinics (GDCs).
Responding on 7 August, John Stewart and Professor James Palmer – Directors of Specialised Commissioning at NHS England – said they are still considering “how best” to pursue the reported issues in a planned review of adult services.
Catalogue of concerns
Dr Cass explained: “The most common concern was the very limited time for assessment and the expectation that patients would be put on hormones by their second visit.”
She said that she was told that consent procedures were “inadequate”, clinical protocols lacking, and administrative processes “chaotic”.
The highly respected paediatrician added: “There was a perception from some that the approach was ideologically driven and polarised and it was difficult to question the approach or discuss concerns.”
Safety concerns were also raised, including poor training and supervision, “unmanageable workloads”, and practitioners reportedly leaving the service “because they were worried that they could not defend their clinical practice”.
New service
Posting the correspondence online, Stewart and Prof Palmer replied: “We appreciate the courage it took for those individuals to speak to you, and we have separately been discussing how best we can support them to share their experiences with this review.”
They said NHS England’s review of GDCs “will carefully consider experiences, feedback and outcomes from clinicians and patients, past and present.”
Onsite visits are scheduled to commence in September 2024. The review’s findings will “inform” a new service specification, which will then be subject to “engagement and public consultation”.
Children and detransitioners
NHS England has recently announced multiple changes to its gender services for kids, including a new service for detransitioners, and the launch of a new clinical trial for puberty-blocking drugs.
The Christian Institute’s Director Ciarán Kelly said: “A new service to help people detransition is welcome. These are the people forgotten in the push to promote ‘trans-affirming’ procedures but they bear the mental, and in many cases physical, scars of the outworking of this destructive gender ideology.
“However, the news that a clinical trial of puberty blockers is to go ahead next year is deeply concerning. Many side-effects of the drugs are already known, including long term effects on fertility, bone density, growth and possibly even brain development. The NHS should not knowingly put children’s health at risk.”
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