NHS gender clinic rated ‘Inadequate’ by Care Quality Commission

NHS England’s gender identity clinic for children has been graded ‘Inadequate’ by the Care Quality Commission (CQC).

The Tavistock and Portman NHS Trust’s Gender Identity Development Service (GIDS), which now operates across two sites in London and Leeds, was downgraded to the CQC’s lowest possible rating.

It found that the safety of its services required improvement and that staff were poorly led.

Keira Bell

The report comes in the wake of the High Court ruling involving ‘detransitioner’ Keira Bell, who was prescribed puberty blockers after just three hour-long appointments at GIDS.

She progressed onto cross-sex hormones – as almost all young people do after taking puberty blockers – and later underwent a double mastectomy.

Bell argued in court that young people cannot consent to the life-altering medical interventions, and last month the senior judges said it was “highly unlikely” children 13 and under could ever genuinely consent, and “very doubtful” 14 and 15-year-olds could either, prompting GIDS to suspend new referrals for the drugs.

The inspection was carried out in October and November last year, amid concerns made by healthcare professionals and the Children’s Commissioner over clinical practice, safeguarding procedures, consent to treatments and an assessment of capacity.

Consent

The report detailed a series of worrying revelations, including that until January 2020 staff had not consistently kept records of “the competency, capacity and consent of patients” referred for medical interventions such as puberty-blocking drugs or cross-sex hormones.

It also found that staff “did not develop all-inclusive care plans for young people. Records of clinical sessions did not include any structured plans for care or further action.”

The report added: “Staff did not fully record the reasons for their clinical decisions in case notes. There were significant variations in the clinical approach of professionals in the team and it was not possible to clearly understand from the records why these decisions had been made.”

Confirming the validity of much news coverage in recent years, inspectors found: “Staff did not always feel respected, supported and valued. Some said they felt unable to raise concerns without fear of retribution”, and that GIDS “was not consistently well-led”.

‘Significant concerns’

Kevin Cleary, CQC’s Deputy Chief Inspector of Hospitals, said: “When inspectors visited the Tavistock and Portman NHS Foundation Trust GIDS in October, we identified significant concerns and took enforcement action by imposing conditions on the registration of the trust.

“We fed back our concerns to the trust and also to NHS England and NHS Improvement. We were extremely clear that there were improvements needed in providing person centred care, capacity and consent, safe care and treatment, and governance.”

He added: “The trust leadership team knows exactly what improvements are needed and we will continue to monitor the trust extremely closely during this time. We will return to inspect services and expect to see these improvements in place and be thoroughly embedded.”