When the Gender Identity Development Service for Children and Adolescents (GIDS) at the Tavistock and Portman NHS trust in London was established in 1983, it was a different era in terms of the medical understanding of gender dysphoria and the cultural debate around appropriate treatments for transgender young people.
The demand for the service was unrecognisable for what it is today: in the past decade alone, the number of referrals to the GIDS went from 138 in 2010-11 to 2,383 in 2020-21.
The announcement on Thursday that the NHS is winding down the service has been celebrated by many vocal – mainly gender-critical – critics. The GIDS has faced relentless scrutiny in recent years, with a number of former staff going public to raise concerns about the “overdiagnosing” of gender dysphoria, the consequences of early medical interventions and the significant increase in referrals of girls questioning their gender identity – which is a trend reflected across Europe and globally.
The controversy deepened in 2020, when the centre was taken to court by Keira Bell, a former patient, who argued she had been too young to consent to the medical treatment overseen by the GIDS that began her female-to-male transition as a teenager. Bell won her initial case but it was overturned on appeal, with the court of appeal reaffirming the principle of Gillick competence that “it was for doctors and not judges to decide on the capacity of a person under 16 to consent to medical treatment”. This was a relief to those who feared a chilling effect on the rights of young trans people.
But the fact is there has been unusual unanimity at both ends of the spectrum of those who concern themselves with healthcare for gender-dysphoric young people. Trans healthcare experts were perhaps more reticent to criticise the service directly, but highlighted the damage done by lengthy waiting times and the impossibility of a London-based service catering for the whole of England and Wales.
In March, a review of gender identity services for young people led by the paediatrician Hilary Cass confirmed what everyone knew: that the service was under “unsustainable pressure” as demand outstripped capacity, resulting in overwhelmed staff and waiting lists of up to two years that left young people at considerable risk of distress and deteriorating mental health.
Cass recommended the creation of a network of regional hubs to provide care and support, a recommendation accepted by the NHS.
The question now is: what happens next? Some initial concerns have been raised about a possible gap in service provision, but patients have been assured there will be a smooth transition to the early adopter hubs in London and Manchester, with the expectation they will become fully operational in spring 2023. A further three hubs are planned.
There are some ethical worries about Cass’s recommendation that access to hormone treatment will be dependent on participation in the research. While it is not unusual to use anonymised data to improve outcomes, it is perhaps an indication of the breakdown in trust between transgender people and the government, in particular since the U-turn on banning conversion practices, that these fears persist.
Specialists at the GIDS say the rise in demand should be kept in perspective – only one in 10,000 young people are referred to the highly specialised service – and that an overrepresentation of girls could equally be an underrepresentation of boys, for whom gender non-conformity tends to be more aggressively policed by peers.
And what impact does this announcement have on the thousands of young people and their families awaiting treatment? Many report having to go private in order to access timely treatment. Waiting lists remain so painfully long that it is unlikely the impact of the new hubs will be felt for some time.