Victoria Hewson is the IEA’s Head of Regulatory Affairs, but writes here in a personal capacity. She is co-founder of Radical. She and Rebecca Lowe, her co-founder, alternate authorship of this fortnightly column on trans, sex and gender issues.
It’s been a busy start to the year for the Tavistock and Portman NHS Trust (the Trust). Its Gender Identity Development Service (GIDS) continues to see record numbers of patient referrals, but early in January the Care Quality Commission (CQC) reported that its service are “inadequate”.
The Trust has also just been given leave to appeal the ruling of the High Court in the Keira Bell case – that children are not capable of consenting to puberty blockers, which the Trust had been involved in prescribing. Meanwhile, whistle-blowers who formerly held senior positions at the Trust have continued to speak out about the ideological capture and groupthink that dominated its practice for years.
In a highly critical report on the GIDS, the CQC found that risk assessment of vulnerable children was poor, and that record keeping (including records on the competency, capacity and consent of patients) had been inconsistent and often did not include reasons for clinical decisions or structured care plans.
Inadequate care for young people with autistic spectrum disorders was specifically highlighted. The GIDS leadership team was criticised (it has now been disbanded), and staff reported feeling unable to raise concerns without fear of retribution. This validates the long-term position of the whistle-blowers who had raised exactly these concerns for several years, and yet had been met with threats of legal action by the Trust.
Surprisingly, given the findings of fact and law by the High Court in the Bell case, the CQC considered that staff at the endocrinology services at UCLH and Leeds Children’s Hospital, who formally prescribe puberty blockers on recommendation from GIDS, “had a good understanding of Gillick Competence and applied this proportionately when obtaining consent from young people”.
This poses the question of whether in fact the CQC has a good understanding of either the GIDS treatments, or the application of Gillick competence. It is also surprising, given the longstanding nature of the problems now identified, the concerns raised by staff members over several years, and the warning signs obvious from a Channel 4 documentary in 2016, that as recently as 2016 the CQC rated the GIDS as ‘good’.
The CQC, a Stonewall Diversity Champion, has fully accepted the contested concepts and vocabulary of gender identity, including in areas in which recognition of biological sex is vital for personal dignity and safeguarding, such as mental health wards and old age care. It seems that its enthusiasm to follow fashionable gender ideology may have blinded it to terrible failings in care, which have damaged hundreds, if not thousands, of children and young people.
The process surrounding the Trust’s appeal in the Bell case has also illuminated the extent of institutional capture by gender ideology. The Trust is appealing the result as it wishes to be able to continue to prescribe puberty blockers for minors, without a court order.
Several organisations applied to intervene in the appeal, that is, to make representations and give evidence. The courts will generally allow interventions in judicial reviews where the intervenors have particular knowledge or expertise that will assist the court and promote the interests of justice.
Coordinated by Jolyon Maugham (yes, him again) and the Good Law Project, pro-gender-identity charities Stonewall and Gendered Intelligence, Brook (the sexual and reproductive health charity), and the Endocrine Society (a US based trade organisation for hormone-prescribing clinicians, not to be confused with the UK Society for Endocrinology), all applied for permission to intervene.
They gained public support from the Royal College of Obstetricians and Gynaecologists, on the basis that the Royal College considers the Bell decision sets a precedent that could “restrict children and young people’s access to sexual and reproductive healthcare”. Aside from inducing a slight queasiness at their commitment to unrestricted contraception and abortions for children, its supportive tweet and hastily produced statement show that the Royal College took its position from the (legally questionable) reaction to the case of activists like Stonewall and Maugham.
Readers may be surprised to learn that the Royal College (motto: “improving healthcare for women and girls everywhere”) has a trans woman (and member of Stonewall’s trans advisory group) as a lay member of its Women’s Network. Lay members are said to “have personal experience of obstetric and/or gynaecological services”. In medical terms, this is (at best) confusing, but it sheds light on the Royal College’s position on the Bell case.
In the event, Stonewall was denied permission to intervene, but the other groups’ applications were successful, and they will be permitted to make representations but not introduce new evidence. Those who expressed concern at the wider implications for Gillick competence of the Bell case may raise an eyebrow at the news that the intervenors are seeking to compel the GIDS to put children on puberty blockers on the basis of parental consent (At present, GIDS requires the consent of the child, and the judges in Bell found that under 16s will generally not be capable of giving informed consent to experimental and life-changing treatments.)
The idea of proceeding with treatment that inexorably leads to loss of fertility and a lifetime of powerful drugs and surgery without the consent of the patient whose state of mind is the determining factor for the treatment is surely more troubling than a misplaced fear that access to contraception may be undermined. As we have emphasised before, since it seems clear that children are incapable of deciding or consenting, here, these treatments should be taken off the table.
The CQC report on GIDS is horrifying, but it is at least encouraging that the service’s failings have finally been formally recognised and action is being taken. While gender identity-activist organisations have focused on the CQC’s criticism about long waiting times for GIDS services (and this should certainly be addressed as the GIDS is operating way beyond its capacity), we hope to see attention being given to the underlying causes of the surge in referrals in the past decade, especially of young girls.
We trust that the Health and Social Care Committee will be looking into this in the course of its inquiry into children and young people’s mental health, and call on that committee, and the Women and Equalities Committee, to hold the CQC to account for its long-time failure to identify and act on the failings of the GIDS before now. The CQC’s approach to sex and gender in its other work should also be examined.
The actions the Trust is taking to remedy the failings of GIDS should be given close scrutiny, too. The chief executive of the Trust has accepted the CQC’s findings and apologised to patients and their families, but sought to place GIDS’ longstanding problems in the context of the service finding itself “in the middle of a cultural and political battleground”. In reality, clinicians and the leadership of the GIDS have been fully engaged in the battle, applying post-modern theories to their practice. Until this approach, and the root causes of the growth in referrals to GIDS, have been addressed, the National Health Service will continue to fail vulnerable children in its care.