More than 1,000 children were referred for puberty blockers at an experimental gender clinic where concerns were ignored to preserve a “gold dust” NHS contract, a new book claims.
Former clinicians at the Gender Identity Development Service (Gids), part of the Tavistock and Portman NHS Trust in London, have detailed how some “incredibly complex” children were placed on medication after one face-to-face assessment, despite many having a variety of mental health or family background problems.
More than a third of young people referred to the service had moderate to severe autistic traits, compared with fewer than 2 per cent of children in the general population. Some identified not just as a different gender, but a different ethnic background, such as Japanese or Korean. One young person had “three different alter egos, two of whom spoke in an Australian accent”.
In the book, former clinicians at the Gids service speak for the first time in detail of their “regret” about the practice of routinely referring under-16s for puberty-blocking and cross-hormone treatment with no concrete data on the long-term effects. They compare it to the Mid Staffs hospital scandal of the 2000s and the doping of East German athletes in the 1960s and 1970s.
The claims come in Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children by Hannah Barnes, which will be released this month.
Barnes, a BBC Newsnight journalist, spoke to dozens of clinicians who worked at Gids, governors at the trust and children and their parents who used the service.
She details how:
• Children as young as three, already living as the opposite gender with a changed name, appearance and pronouns, were referred to the service.
• The clinic accounted for almost 30 per cent of the Tavistock NHS Trust’s income by 2021 and staff said it resembled a “tech start-up” with regular trips to international conferences.
• In 2016, Susie Green, former head of the pro-trans charity Mermaids, emailed Dr Polly Carmichael, who was then the head of Gids, asking to cut the time children had to spend on puberty blockers before irreversible cross-sex hormones could be introduced.
• Staff raised concerns when, on behalf of families, Green requested children’s clinicians to be changed to someone believed to be more likely to prescribe hormones.
• In her first interview since winning an employment tribunal case after she raised concerns about the safety of children, the trust’s head of safeguarding, Sonia Appleby, said anyone who spoke out was “demonised”.
• Former therapists involved in prescribing puberty blockers now admit they do not know “how many children [have since] changed their mind” on transitioning.
Founded in 1989, Gids, formerly the UK’s only dedicated gender identity clinic for children and young people, was told to shut last year after an independent review led by Dr Hilary Cass concluded that young people were left at “considerable risk” of poor mental health and distress. A Care Quality Commission report had rated the service “inadequate” and criticised its record-keeping.
Data shows 354 children under 16 consented to puberty blockers at University College London Hospital Trust and Leeds Children’s Hospital between 2012 and 2021 after being seen by therapists and psychologists at the clinic. Between 2009 and 2017, 1,261 children and teenagers were referred for medical intervention. Gids said the “vast majority” were prescribed the blocker.
After initially treating just a handful of patients each year, referrals to Gids increased dramatically. In 2009-10 it received 97. By 2019-20 it received 2,748 — a rise of more than 2,700 per cent. The youngest child known to have been referred to endocrinologists at the University College London Hospital Trust was seven. The child was later treated privately.
The numbers far exceeded what had been planned for and many staff members felt overwhelmed.
Therapists who worked at the clinic have spoken of staff trying to do the best for young people but assessments quickly began to feel rushed. A number of young people have reported that they felt Gids staff listened to them and have spoken positively of their treatment there.
But Dr Anna Hutchinson, a senior clinical psychologist at Gids, said the service was soon “accepting everyone”. She said puberty blockers were supposed to be prescribed to children to give them “time to think” about whether they wanted to transition fully, but she realised that almost all went on to take cross-sex hormones, such as testosterone and oestrogen, which have irreversible consequences.
Hutchinson told Barnes this was a “holy f***” moment. “It totally exploded the idea that when we were offering the puberty blockers, we were actually offering time to think,” she said.
“Because what are the chances of 100 per cent of people, offered time to think, thinking the same thing? If the service was getting this wrong, it was getting it wrong with some of the most vulnerable children and young people.”
She now believes that “some of those kids would not have identified as trans had they not been put on the medical pathway”.
“Of course, that doesn’t mean to say that identifying as trans is a bad outcome,” she said. “But what is a bad outcome is creating a cohort of people who are medically dependent who’d never needed to be. And not only medically dependent, but perhaps — we don’t yet know — medically damaged.”
She describes the service as “scandalous in its negligence and scale”.
In 2011, Gids began an “early intervention” study in which 44 patients aged 12 to 15 took part to see the longer-term effects of puberty blockers. But in April 2014 the practice of prescribing blockers to under-16s was introduced across the service before the data on their effects was available. A lower age limit of 12 was removed as Gids relied on a “stage, not age” approach based on where a child was in their development.
There are concerns about whether puberty blockers “temporarily or permanently” disrupt the development of children’s brains, as well as potentially stunting growth and affecting bone strength. Little is known about the long-term side effects.
Anastassis Spiliadis, a family therapist, told Barnes of the impact of outside groups, and parents, on decisions to refer often vulnerable children for puberty blockers.
He said in his four years at the service, on two occasions he decided that children from complex family set-ups and backgrounds should not be placed on blockers. However, the families complained and “both ended up on the blocker”.
Parents who complained were referred to “clinicians who we all knew it was much easier to get on hormones through them, rather than other clinicians”, he said.
There were also concerns that parents were pushing children into transitioning, in cases of fabricated or induced illness (FII), previously known as Munchausen’s syndrome by proxy.
In one case, he said, the child told him, “my mum wants this for me”, or “my mum wants the blocker more than I do”. He said there was sexual abuse and domestic violence in the family and he and a colleague agreed that they would not be putting the young person forward for puberty blockers. However, this decision was allegedly overruled by Carmichael.
On other occasions a change in clinician would be requested by Green, the Mermaids chief, Spiliadis said.
“I remember thinking and talking to Paul [Jenkins, the Tavistock chief] and saying that this is really inappropriate — how come a person who’s the director, or the CEO of a charity, is entitled to request a change of clinicians on behalf of a family?”
On his time at Gids, Spiliadis added: “We’re like, ‘Oh my God, will we look back in ten, 20 years and be like, what did we do?’”
Matt Bristow, a former Gids clinician, added: “Despite the obvious complexity of all these cases — sexual abuse, trauma, potential FII — the answer was always the same. That the young people eventually get put on the blocker unless they themselves say they don’t want it.”
Whistleblowers also allege the clinic, which treated under-18s suffering from gender dysphoria, was “institutionally homophobic” and bowed to pressure from parents who preferred their children to be transgender rather than gay. When homosexual clinicians raised concerns it was becoming a “conversion therapy for gay kids”, they were ignored because they were deemed subjective, it is claimed.
Barnes’s book refers to the financial benefits the Gids service brought to the Tavistock trust at a time when NHS services were under immense financial pressure.
Dr David Bell, a psychiatrist and former staff governor at the trust who wrote a critical report on the service in 2019 after being approached by a number of concerned employees, said the Gids national contract with the NHS — where it did not have to compete with another service — was “gold dust”.
“Bell argued that knowledge of Gids’s economic importance had made it difficult for those with legitimate criticisms to raise them,” Barnes writes.
Spiliadis added that, after not even having an office when he arrived, Gids “eventually took over a whole floor”. “But because it was bringing in so much money they [senior trust staff] could not challenge it,” he added.
Hutchinson said that with high pay, trips to transgender conferences in Europe and as far afield as Buenos Aires, the culture of Gids “more closely resembled a tech start-up than the NHS”.
As well as criticisms, a 2019 review by the medical director, Dinesh Sinha, following Bell’s report also heard positive testimony from staff members, who said they did not see any problems with Gids’ safeguarding practices.
But Sinha did not raise concerns passed to him during the course of his review with Appleby, the safeguarding head. When she finally saw the transcripts she said it was not only a “tragedy for the patients involved” but a “tragedy for the organisation — that so many of these narratives had been muzzled, and the people who had raised these concerns were demonised”.
Bristow said Sinha’s report was a “whitewash”.
The Tavistock and Portman NHS Trust said: “Gids works on a case-by-case basis with every young person and their family, working thoughtfully and holistically with them to explore their situation, with no expectation of what the right outcome for them might be. Only the minority of young people seen in the service are referred for any physical interventions. At the Tavistock and Portman we wholeheartedly support our staff to raise concerns, and have recently strengthened our mechanisms for doing so. Concerns relating to young people’s wellbeing are taken seriously and investigated.”
The Tavistock said it had records of only one patient being referred for medical intervention after one assessment and this person had gone through a detailed assessment at another gender service.
Mermaids declined to comment.
