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Gender Identity Services: Children and Young People

Volume 829: debated on Wednesday 19 April 2023


Asked by

To ask His Majesty’s Government what steps they are taking to ensure that, during the closure of the Tavistock gender identity clinic, young people who accessed those services receive appropriate counselling, as recommended by the Cass Review of gender identity services for children and young people.

NHS England commissions children’s and young people’s gender identification services. All patients at the Tavistock gender clinic receive psychological or psychotherapeutic care. Following the Cass review interim report, NHS England is bringing the GIDS contract to a managed close and transitioning gender services to new providers that will deliver holistic and exploratory counselling. Existing patients will continue under the current care arrangements until they are transferred to new services based in specialist paediatric hospitals.

My Lords, I thank the Minister for his reply, but I would like to probe a little more on this. Does he recognise that 80% of the young people who are diagnosed with gender dysphoria, many of whom are girls on the autistic spectrum, realise when they reach the age of 18 that they have gone through a perfectly normal process of puberty? They might end up being gay or lesbian, but they certainly did not need to be prescribed puberty blockers, which are a serious medical risk. Can the Minister assure me that steps will be taken to ensure that those young people receive the appropriate counselling? It could be via CAMHS, but what it cannot be, as he rightly said, is through the discredited Tavistock clinic—and I would like to meet the Minister on this issue.

Yes. As I have said before, it is one of the privileges of this job that you learn about new areas, and I thank the noble Lord for his Question; this is something I have enjoyed being educated on in the last few days. I am very happy to meet with him. The points he makes are absolutely right: a lot of these people have other issues and going through puberty is a difficult time. So the lessons have been learned and we will make sure that they are implemented.

My Lords, I thank the Minister for his thoughtful reply to the Question and his curiosity about this subject area. I think that some issues and data that have just been shared are subject to debate and are not quite as substantial as has been suggested. When might the transition to these new services happen? At the moment, the young people on that waiting list have no knowledge of when they will be transitioning from the Tavistock to another service; there are those who have been waiting for an appointment since 2019, and four years is a very long time when you are a teenager, let alone when you are 43 and a half and a grown-up. We also know that that period is a very confusing time, so could we get some clarity for those young people on when they will be seen, by what service, and how quickly they will be able to get on to the system?

The points are well made, and they are understood and accepted on this side. My understanding is that the northern and southern hubs, as recommended in the Cass review, have already been set up, so patients are being seen as we speak at the Great Ormond Street and Evelina centres, and a transition programme is being put in place for all those people who are currently there. I will happily pick up with the noble Baroness afterwards to discuss this further.

My Lords, the number of autistic children and adolescents at the Tavistock clinic was greater than the number of those in any other group. Would my noble friend just clarify his reply a little? I think this is going to require more than normal counselling, because there is a trait within the autistic mind that often focuses very strongly on a particular issue and, once an autistic person believes something is true, it is quite hard to get them to see it another way. So it is going to need expertise. What is being done to find those experts?

My noble friend will be aware that I do have some personal knowledge in this area, and I recognise very much the point that neurodiverse people can become fixed on a certain outcome. In terms of the statistics, yes, as many of a third of the people seen at Tavistock do have those sorts of conditions. So, it is something that is understood. Again, I am happy to pick up afterwards. The key point of the Cass review in all this is that these people need to be seen by medical doctors who are considering everything in the round and not just coming at this through a gender identification lens. That is the key thing we need to make sure happens going forward.

My Lords, whatever one’s views on trans issues, surely the first imperative is to ensure that young people are properly looked after. Would the Minister agree with me that every young person suffering from gender dysmorphia, whether they have attended the Tavistock or not, should receive professional counselling and support? If he does agree, can he ensure that the resources are available in a timely manner, so that these young people do not have to wait years while they try to unravel the complex set of issues they face concerning their gender identity?

Again, my understanding—and I freely admit that the benefit of having these questions is that you then delve into them, which I very much support in terms of how this process works very well —is that these people who have been through these services need to be looked after and catered for, so that is something we are very much on.

My Lords, leaving aside the issue of the serious psychological problems some of these children undoubtedly display, can the Government clarify one issue? Do they regard so-called gender dysphoria, which is a very broad term, as a pathological condition or simply a medical one? Is it a pure choice of the individual? Therefore, the question is: at what stage should the National Health Service be intervening in these cases?

I feel I am probably outgunned to some degree by the noble Lord. I would like to make sure that I answer that in the proper way and give him a detailed written response. I am happy to follow up, because I want to make sure that I am answering in completely the right way.

My Lords, the Times of 23 February reported that GIDS patients were still receiving puberty blockers. What arrangements are in place—as recommended by Dr Cass in her report—to monitor patients who receive treatment, both during it and in subsequent years by way of follow-up, to ensure a proper longitudinal study of the effects?

My noble friend is absolutely correct: one of the main findings from the Cass review was that more research has to be done in the whole space of puberty blockers. The NHS is moving on that as we speak. At the same time, I can assure the House that, from now on, no puberty blockers can be prescribed unless they are part of that research programme, because it is vital that that does not happen as a matter of course until we understand far more about this subject.

My Lords, the Cass review interim report underlines that the expansion of gender identity services to regional centres can be successful only if the NHS can attract and engage the workforce within those centres and for crucial network secondary services. This week, however, as we have heard, we have seen just how under pressure these key services are. Over a quarter of a million children in Britain with mental health problems are awaiting NHS referral due to major shortages of psychiatrists and specialist nurses. How are the holistic, person-centred services that young people desperately need going to be provided in the continued absence of a clear government workforce strategy?

I am glad to say that there is a workforce strategy, which, unfortunately, we have not been able to publish yet. I assure your Lordships that a lot of work is being done, and there is a lot of work in place. I would be happy to meet with the noble Baroness and go through the findings of that, because it needs to cover a lot of these specialisms.

My Lords, in reply to the question from the noble Baroness, Lady Hunt, the Minister referred to the new GID services at the Evelina and GOSH. But the original proposals were for regional clinics in Manchester and London—so when will the Manchester clinic open? Since March of this year, the waiting list and all new referrals are being held by the Arden and Greater East Midlands commissioning support unit. There is real confusion about how this list will be integrated with the existing case load as the new services open. Can the Minister explain what will happen? If he does not have the answer to hand, please will he write to me?

As ever, I am very happy to write. In terms of the northern hub, I mentioned GOSH and Evelina just as examples. The Royal Manchester and Alder Hey are the northern sites that will be used to provide these services. The idea is that we will have eight regional centres—but I would be happy to provide the detail on both cases and follow up in writing.