UK, Aug.5, 2023: Children as young as seven will get transgender treatment on the NHS, according to plans seen by The Telegraph.
In details of the new service to replace the controversial Tavistock clinic, NHS England has set out how it will limit the use of puberty blockers and ban activists and teachers from referring children for treatment.
For the first time, it has set a minimum age of seven for referral to the gender identity clinics.
These children will be offered psychological support and therapy that will focus on issues that may have led to their feelings about their gender.
However, experts have warned that the age restriction could still put young children with mental health problems on a “pathway to medical transition”.
Campaigners welcomed the “move toward an evidence-based approach”, but said there was still work to be done to ensure children are kept safe.
‘Structural problem’
The NHS announced last year that it would be closing the Tavistock transgender clinic after a review by Dr Hilary Cass found it was “not safe”.
It was the only NHS transgender clinic treating children and concerns were raised that young people were being rushed down a medical pathway.
The clinic is being replaced by a set of regional centres that will be led by medical doctors, rather than therapists, and consider the impact of other conditions such as autism and mental health issues.
The move came amid growing concern about the impact of gender ideology on children, including in schools where some were being socially transitioned without their parents’ consent.
NHS England said that a new service was needed because there was “scarce and inconclusive evidence to support clinical decision-making” at the Tavistock clinic.
As part of the new approach, medics have been reminded that for “most” young people, the feeling of being in the wrong body is just a “phase” and does not persist into adulthood.
Officials have now set out their plan for how children will be able to access the service, which has been sent to experts for their input. The plans have been seen by The Telegraph.
The plans state: “Children under seven years of age may not be expected to have sufficiently developed their intellectual understanding of, and comprehension of, sex and gender to be able to understand the reasons for, and potential consequences of, a referral to a specialist gender incongruence service.”
By seven, children will “be more established within school, and education professionals and school nurses will be able to contribute to a general observational view as to the appropriateness of a referral”.
Previously, there was no minimum age for referral and children as young as three were treated by the Tavistock. On average, three children aged under seven were being referred every month.
Dr David Bell, a consultant psychiatrist and former governor at the Tavistock before he became a whistleblower about the clinic’s work, said: “For me, there is a structural problem which needs particular caution: referring a child to a gender service, even if they are seen in the context of a multidisciplinary team, in that the mere fact of referral is consequential.
“It risks the child’s difficulties being viewed by themselves and their family as primarily to do with gender. Labelling the problem as a gender problem can easily be the first step on a pathway to medical transition.
“My view is that certainly for the younger ages, children should be managed within the context of the ordinary Child and Adolescent Mental Health Services (CAMHS).
“Their difficulties should not be designated as a gender problem, it is much more appropriate that they be seen as individuals who are distressed and this is one way in which that distress is expressed.”
Dr Bell also described the definition of gender incongruence in childhood included in the specification as “dangerous”. It says it is characterised by “make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex”.
The definition, which comes from the World Health Organisation, is “completely the wrong way of looking at it”, said Dr Bell.
He added: “We are corrupting a child’s capacity to have an imagination and imposing a gender stereotype on them.”
‘Devil is in the detail’
The new service plan also states that a child can only be sent for gender treatment by specialist NHS mental health or paediatric services.
It comes after revelations by this newspaper that Susie Green, then chairman of controversial charity Mermaids, had been able to refer children even when their GP repeatedly refused. Teachers and social workers had also previously been able to refer children to the Tavistock.
The Government is set to release transgender guidance for schools that will make it harder for children to socially transition in the classroom.
NHS England said that the change will ensure children are receiving help while on the waiting list, which currently stands at three years.
In recent days, NHS England has also released further details on its ban on prescribing puberty blockers outside of clinic trials, saying it has “concluded that there is not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones to make the treatment routinely available at this time”.
Only children who have experienced early-onset gender dysphoria starting at a young age will be eligible for the trials.
Blockers have previously only been prescribed when children start to develop secondary sex characteristics.
NHS England says that the ban will impact children aged between around 10 and 17. As of July 2022, there were 378 children and young people being treated by the NHS endocrine clinic that prescribes blockers.
Stephanie Davies-Arai, founder of Transgender Trend, said there were still questions about the age at which the children would be allowed onto the trial. She said the “devil is in the detail”.
“This new service is a huge step forward,” she said.
“But there is still a lot of work to do and a lot of detail to be worked out.
“I have still got questions about children being enrolled in an experiment on puberty blockers where the benefits haven’t been proven and the long-term risks are huge.”
Sajid Javid, the former health secretary, said: “I welcome the NHS finally taking a cautious, research-driven approach to assessing these treatments. This should be handled as carefully as any other child protection issue.
“The extent to which these hormones have been officially prescribed for this purpose is concerning given the lack of evidence base on their long-term effects.
“While that remains the case, there should be a very high bar for their usage with children.”
