NHS England has confirmed that puberty blockers will no longer be prescribed for children at gender identity clinics. The Government has expressed support for this “landmark decision,” stating that it will help ensure care is based on evidence and in the “best interests of the child.”
Mitigating the Disaster
This recent decision follows a public consultation and an interim policy, as well as an independent review commissioned by NHS England in 2020 of gender identity services for children under 18. The review, led by Dr. Hilary Cass, took place after a significant increase in referrals to the Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust, which is set to close at the end of March. In 2021/22, there were over 5,000 referrals to Gids, compared to just under 250 a decade earlier.
The clinic has faced continuous scrutiny. In February 2022, Dr. Cass released an interim report highlighting the need to shift away from a single unit and recommending the establishment of regional services to better support young individuals. Additionally, she pointed to a lack of long-term evidence and data collection regarding the outcomes for children and young people prescribed medication.
Move Toward Holistic Care
Dr. Cass emphasized that Gids had not collected routine and consistent data, making it impossible to accurately track the outcomes and pathways that children and young people take through the service. After the Tavistock’s closure, two new NHS services will open in early April at London’s Great Ormond Street Hospital and Alder Hey Children’s Hospital in Liverpool. The NHS stated that children attending these clinics will be supported by clinical experts in neurodiversity, pediatrics, and mental health, resulting in a holistic approach to care. Health minister Maria Caulfield said, “We have always been clear that children’s safety and wellbeing is paramount, so we welcome this landmark decision by the NHS. Ending the routine prescription of puberty blockers will help ensure that care is based on evidence, expert clinical opinion, and is in the best interests of the child.”
Is It Enough?
The consultation on the future of services received over 4,000 responses, with around a quarter from members of the public, 22% from patients, 21% from parents, 10% from trans adults, and 5% from clinicians. John Stewart, national director of specialized commissioning at NHS England, told the PA news agency, “Given that the debate is often very polarized, so too were the responses to the consultation. Many people said the policy didn’t go far enough in terms of still allowing potential access through research,” because NHS England has decided to limit the availability of puberty blockers to children participating in clinical research trials. While the agency aims to continue providing access to these medications through a controlled scientific environment, it is crucial to consider that children who cannot give consent to puberty blockers cannot give consent to have these drugs tested on them either.
The New Clinics
Regarding the new clinics, Stewart added, “This is just the first step in building a regional model, where our aim is to establish between seven and eight specialist centers including the north and the south hubs over the next year to two years.”
“Around 250 patients are expected to be transferred to the new clinics from Gids when they open. Some 5,000 more children and young people are currently on the waiting list for referral into the new clinics.
Mr. Stewart said, “Our two new providers on their own are not going to be able to make a significant dent immediately in that waiting list, but what they are doing is helping us establish a new and fundamentally different service model, in line with advice from the Cass review.”
He added that other regional centers could hopefully be commissioned quickly, and once that point is reached, “we should begin to see significant movement in that waiting list and numbers falling.”
The speed and pace at which the clinics will be able to see new patients off the waiting list is in large part going to be dependent on how successful their ongoing recruitment into the service is, and that is not straightforward.
“Fewer than 100 young people are currently on puberty blockers, who will be able to continue their treatment and are being seen by specialist endocrine services at Leeds and University College London Hospital.
It is understood NHS England hopes to have a study into the use of puberty blockers in place by December 2024, with eligibility criteria yet to be decided. However, in 2021, The National Institute of Health and Care Excellence (NICE) released a review that highlights the “very low” quality of evidence supporting the use of puberty-blocking drugs in treating young individuals experiencing gender identity challenges. The assessment, commissioned by NHS England, reveals that existing studies on these medications are limited in scope and subject to potential biases and confounding factors.
Hopeful Legislation
Former prime minister Liz Truss, whose Health and Equality Acts (Amendment) Bill includes a ban on the prescription of body-altering hormones to children questioning their sex, both privately and on the NHS, said, “I welcome NHS England’s decision to end the routine prescription of puberty blockers to children for gender dysphoria. I urge the Government to back my Bill on Friday which will reinforce this in law and also prevent these drugs being supplied privately.”
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