Increased demand for the only NHS gender identity service in England and Wales has resulted in an "unsustainable workload", according to an inquiry.
The interim report of the Cass Review says the current clinical model of a single specialist Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust was no longer appropriate.
The Review, chaired by paediatrician Dr Hilary Cass, was commissioned by NHS England to make recommendations on improving services provided by the NHS to children and young people with gender incongruence or dysphoria. It was also asked to ensure that the best model was used for commissioning safe and effective services.
Children Presenting with Complex Needs
It found there had been a rapid increase in the number of children requiring support, and that the complexity of needs meant that their interests would be better served by diversifying into regional hubs.
The report acknowledged "growing concern about how the NHS should most appropriately assess, diagnose, and care for this population of children and young people", and recognised there were "significant gaps" in the research and evidence base. A lack of consensus and open discussion about the nature of gender dysphoria resulted in uncertainty about the appropriate clinical response.
Neither had there been routine and consistent data collection, which meant it was not possible accurately to track the pathways and outcomes for young people, it said.
The inquiry also found that as the service at the Tavistock and Portman had evolved "organically", its clinical approach had not been subjected to some of the usual control measures that were typically applied when new or innovative treatments are introduced.
Other Recommendations
Among the key points for the future, the Cass Inquiry recommended that:
- Children and young people with gender incongruence or dysphoria must receive the same standards of clinical care, assessment, and treatment as every other child or young person accessing health services
- There needs to be agreement and guidance about the appropriate clinical assessment process that should take place at primary, secondary, and tertiary level, underpinned by better data and evidence
- Service transformation was needed to address the challenges, with a service model more in line with other paediatric provision, including support for other clinical presentations
A Tavistock spokesperson said: "The Tavistock and Portman NHS Foundation Trust welcomes the focus of Dr Cass and her team on increasing and broadening the care and support available for this group of patients who are currently waiting far too long and on developing the evidence base.
"We will work with her and NHS England to support her recommendations."
In January 2021, the Care Quality Commission told the Tavistock that its services and waiting times for GIDS must improve significantly. During an inspection in autumn 2020 it rated the GIDS as 'inadequate' overall.
Last September, the Court of Appeal overturned a judgement that children under 16 with gender dysphoria were unlikely to be mature enough to give informed consent to be prescribed puberty-blocking drugs.
In its interim report, the Cass Inquiry said it was not currently able to provide definitive advice on the use of puberty blockers and feminising/masculinising hormones due to gaps in the evidence base, but that recommendations would be developed as the evidence base was compiled.
Lead Image Credit: Getty Images
