NHSE sanctions limit basic healthcare for young trans people

NHSE sanctions, mermaids
© Juan Moyano

Lui Asquith, Director of Legal and Policy at Mermaids, dissects new NHSE sanctions placed on young trans people looking for basic healthcare

Despite the Court of Appeal unequivocally stating that transgender patients can consent to puberty blockers in the widely covered Bell v Tavistock case, there have continued to be further NHSE sanctions placed on young trans people attempting to access basic healthcare support without any clear understanding as to why.

What is the latest NHSE amendment?

The NHSE amendment published several weeks after the Court of Appeal’s damning decision refused to remove the requirement of an ‘multi-professional review group’ (Review Group). This Review Group has now been realised to independently and systematically request that GIDS gather sensitive family data and information when assessing a young person’s needs, with no clear authority. Families are feeling as though they have no choice but to consent to release their personal information in effort of reducing the risk of any further delay to their child accessing support.

The Review Group is being seen by service users as an additional roadblock on an already time-consuming, slow, and drastically ill-equipped NHSE service that is directly impacting the lives of trans young people and their families. Patients clinically recognised as struggling with gender dysphoria are being indirectly forced to access private healthcare or face irreversible changes to their body such as their voices breaking.

“additional roadblock on an already time-consuming, slow, and drastically ill-equipped NHSE service”

Blanket approach to requesting sensitive personal information

We wrote to NHS England on 11 November 2021 to express our concern around its seemingly blanket approach to requesting sensitive personal information. Specifically regarding social work and safeguarding paperwork, which contradicts Government guidance around requests for sensitive information needing to be necessary and proportionate. We have had no response from NHSE to our letter, to date.

In response to one parent questioning the Review Group’s authority to request sensitive personal information, NHSE states that: “The Review Group does not offer second opinions on clinical matters. Instead, it is there to provide assurance that the correct procedures have been followed by GIDS in reaching the recommendation to refer children under 16 to endocrinology clinics for puberty blockers.”

It goes on: The Tavistock has publicly welcomed the Review Group’s establishment and role. Once it has from GIDS all the information it needs on an individual case, the Review Group is able to turn round requests for approval for referral very quickly.”

“I believe it to be discriminatory” says GIDS clinician

Reports from within the Tavistock do not tally with NHSE’s statement that the Tavistock welcomes this requirement for sensitive information, or the need for the group itself.

A GIDS clinician said: “We can’t think of any area of healthcare where decisions about diagnosis and treatment need to be sanctioned by an external panel who have never met the young person. They will argue it is an audit of the process. But that’s not true when it can and does delay access to treatments. I believe it to be discriminatory.”

Of course, careful decision making in any area of healthcare is crucial and no-one disputes the importance of this. What seems to be transpiring here however is an extra, unique hurdle for registered and expert clinicians to go through before an individual can access the care they need at that time, within one area of healthcare.

A time that is particularly critical for those who struggle with bodily dysphoria.

A parent, speaking anonymously, said: My child  is currently 11 years old, nearly 12. We have been under the GIDS service at the Tavistock and Portman since 2015.  We learned that there was a new stipulation that required checks with social services that there was no involvement with the family and no safeguarding concerns. There was no clear guidance, no referrals and barrier after barrier put in place to prevent her timely care and treatment. This has left our family in a dire situation with minimal support and no medical intervention. NHS England and GIDS as a whole have failed my child and my family as a whole.”

“left our family in a dire situation with minimal support and no medical intervention”

Why is this happening after such clear direction from the Court of Appeal – that the decision around puberty blockers are a decision for the individual and their doctor, not the court?

The Review Group has anonymous power over only trans youth

The Review Group of course is not a court, but a panel of strangers who have never met the young person. A panel of strangers granted a power to restrict access, when it has been identified by expert clinicians to be in the best interests of an individual – an individual that has been waiting years for support. Importantly, why is the Review Group assessing decisions around trans young people only and not to the wider population? Surely if this level of private family history and scrutiny is relevant and of major consideration in terms of providing healthcare, it should be required for every person under 16?

Of course, sometimes this information may be relevant in relation to healthcare decisions, but starting at a de facto assumption that it is – which is how it is feeling on the ground – with no obvious reason other than the fact this area of healthcare is in relation to trans young people is highly concerning.

Treating LGBT+ healthcare as exceptional has been a forever relentless challenge within our communities and be in no denial: trans kids are the next victim of a cisnormative, heteronormative style bureaucracy. We need to act now and sort this before a whole generation of trans young people have their lives negatively impacted by another form of LGBT+ prejudice and neglect.

We have heard firsthand how damaging this is from families sharing their concerns.

One parent commented: “My daughter’s mental health was declining and signs of male puberty were happening which was very distressing for her and us as a family. It’s a very frustrating situation we find ourselves in and the system needs to change as it’s not fit for purpose.”

Another, reflecting on timeframes, said: “It’s coming up to 2 years since we approached the Tavistock to say that my child was showing signs of puberty. We have been failed so much by the system, it’s utterly devastating.”

Mermaids calls for the Review Group process to be reconsidered

Mermaids is the only charity in the UK that supports both trans and non-binary young people as well as their families. Considering this we are using our voice to say that this practice is unacceptable and actively damaging a population of young people, who should have the same right to access the healthcare they need as the next young person. Being trans is not a safeguarding issue and requiring puberty blockers to feel comfortable is not a safeguarding issue. Affirming children in their gender has only positive impacts on their mental and physical health. Requiring them to experience puberties that do not align with their gender identity has lasting and negative consequences. Stop pathologizing and demonising these families.

We are calling for the Review Group process to be itself reviewed immediately and for approaches to trans healthcare and gender affirming treatment to fall in line with the approach to the wider population.

We want to say to all trans, non-binary and gender diverse young people, and their families, we stand with you and will continue to push for change.

We are here to offer support, please do reach out if you need it – you are not alone.


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