The report on the Tavistock GIDS, broadcast on Newsnight on Thursday, is the latest installment of a news story that began in 2018.
Towards the end of that year, David Bell, a senior clinician and staff governor at the Tavistock and Portman NHS Trust, produced an internal report containing testimonies from GIDS clinicians, which prompted an internal review. Around the same time a group of parents had submitted a letter to the trust’s board detailing their concerns that young people were being fast-tracked through the service. The Guardian reported on their letter and also on some content they had seen in the Bell report:
“Britain’s only NHS gender identity service for children is reviewing its operations amid claims made by a senior member of staff that it is failing to examine fully the psychological and social reasons behind young people’s desire to change gender.”
In response to the Guardian’s questions about the contents of the report, the Tavistock responded and were quoted:
“The trust is concerned by the tone and manner in which these allegations have been made. They reveal a negative attitude to gender dysphoria and gender identity which does not reflect the views or the approach of the trust.”
Given that the leaked contents of the Bell report suggested serious concerns by clinicians, the review, carried out by the trust’s medical director, Dr Dinesh Sinha, was eagerly awaited – not least by the parents who had written to the trust. In the event, the review accepted some criticisms but failed to reference or address the serious concerns that had been reported by the Guardian.
The Sinha review was followed by an action plan published in March 2019. Paul Jenkins, Chief Executive of Tavistock & Portman NHS Foundation Trust, suggested in the announcement of the plan that concerns had been expressed by only one staff member, from outside GIDS:
“The Trust’s newly appointed Medical Director was commissioned to carry out a Review to explore concerns raised by a member of staff external to the Service.
“The Review did not identify any immediate issues in relation to patient safety or failings in the overall approach taken by the Service in responding to the needs of the young people and families who access its support.”
By then the Bell report had been leaked to the Sunday Times. The contents of the report revealed that the GIDS’ own doctors had “very serious ethical concerns” about children embarking on a life-changing medical pathway without adequate examination or ability to give informed consent.
“It says some children “take up a trans identity as a solution” to “multiple problems such as historic child abuse in the family, bereavement . . . homophobia and a very significant incidence of autism spectrum disorder” after being “coached” online and by trans activist groups.
The true histories of “highly disturbed or complex” child patients were not properly explored by Gids clinicians struggling with “huge and unmanageable caseloads” and afraid of being accused of transphobia if they questioned the “rehearsed” surface presentation. The report says the concerns voiced by staff are shared by Sonia Appleby, who is in charge of safeguarding at the trust.”
The Tavistock responded to the leak with a statement no longer available on their website, but archived here, suggesting this time that some unqualified people had produced an unverified report:
“We are disappointed this unsubstantiated report authored by individuals with no expertise in this field made its way to the Sunday Times and would urge caution about reproducing its content. We do not accept that the vignettes included next to the article are helpful, or representative of the clinical work of the service.”
Marcus Evans, governor and consultant psychotherapist at the Tavistock and Portman trust with three decades’ experience, subsequently resigned, telling the Sunday Times that “the trust had said things that were “not true”, had created a “climate of fear” and was trying to “dismiss or undermine” concerns raised by its own clinicians.””
“I am sad to be ending my proud 34-year association with the trust,” Evans wrote in his resignation letter. “However, I do not have confidence that these serious issues . . . are going to be sufficiently addressed and dealt with in a thorough, thoughtful and balanced way.”
Further critical concerns, this time from former Tavistock clinicians, were reported in the Times in a series of reports from Lucy Bannerman here, here and here, in an issue on April 8th 2019 that also included a comment piece by Dr Carl Heneghan, in which he described the off-label use of drugs for gender dysphoria “an unregulated live experiment on children.”
The Tavistock responded in a statement:
“We strongly reject the claims made in the articles in the Times. The Service always place a young person’s wellbeing at the centre of our work and have a clear position of independence from outside lobby groups on all sides of the debate.”
In July the concerns of the Tavistock staff in London were echoed by a former clinician at the Tavistock Leeds clinic, Kirsty Entwistle, in an open letter to Polly Carmichael.
“I think it is a problem that GIDS clinicians are making decisions that will have a major impact on children and young people’s bodies and on their lives, potentially the rest of their lives, without a robust evidence base. GIDS clinicians tell children and families that puberty blockers/hormone blockers are “fully reversible” but the reality is no one knows what the impacts are on children’s brains so how is it possible to make this claim? It is also a problem that GIDS clinicians are afraid of raising their concerns for fear of being labelled transphobic by colleagues.”
Also in July Newsnight had reported on the Tavistock puberty blockers trial. The report exposed the finding (in some unpublished results) that after a year on blockers a significant increase was found in the first item “I deliberately try to hurt or kill self” in the Youth Self Report questionnaire, a finding by Michael Biggs in his research which was first published by Transgender Trend.
In January this year, Sue Evans, a Psychotherapist, Nurse and ex member of the Tavistock GIDS launched a Judicial Review into the NHS use of puberty blockers, on the grounds that children cannot give informed consent to such experimental treatments. The case has been taken up by Keira Bell, a detransitioned young woman who underwent hormonal treatment at the GIDS, in a joint action with the mother of an autistic girl.
Sue Evans had raised her concerns with the service as early as 2012. An article in the Times ahead of the application for judicial review reported:
“Ms Evans, 62, reported her alarm at the speed of assessment and feared that treatment plans were being influenced by groups such as Mermaids, a transgender advocacy charity.”
In response a Tavistock spokesperson said:
“Our clinical interventions are laid out in nationally-set service specifications. NHS England, monitor our service very closely. The service has a high level of reported satisfaction and was rated good by the Care Quality Commission.”
This is the background and context of the Newsnight report. It was hard to imagine that there could be any new revelations about the Tavistock GIDS by this stage, but the programme revealed “evidence exclusively seen by Newsnight” that suggested even more serious concerns than we had heard before.
Producer Hannah Barnes and reporter Deborah Cohen had seen “well over 100 pages of transcripts, of interviews conducted with staff as part of the review.” Some of the “series of complaints” were familiar from the leaked Bell report, which the Tavistock had attempted to minimise and discredit, but some went further.
“They say decisions about medical treatment were taken too quickly. And they say that some parents appear to prefer that the child was transgender and straight rather than gay – pushing them towards transition.”
“Many children referred to GIDS are extremely distressed and have complex needs. The clinicians we have spoken to say there is often lots to explore before medication should be considered. But they say there is wide variation in practice. It is claimed in the transcripts that many staff are worried and openly discuss their fears.”
“People who raise concerns are seen as troublemakers and difficult. I think it is the case that somehow the organisation works to evacuate people who are not compliant. When I raised concerns I was told that I had to toe the line or I would not progress in my career.”
One clinician was quoted as saying:
“Maybe we are medicating gay children, kids with autism and maybe medicating traumatised children. And if we are, we are doing bad things to these vulnerable kids.”
“Let us pray that I am wrong. Because if I am not, very many vulnerable children have been very poorly treated and will be left with potentially a lifetime of damage. We’re not talking about little things. The reality is by not doing anything, children are potentially still being medically mismanaged.”
Of even greater concern is the fact that staff reported being discouraged from taking concerns about a child’s welfare to the lead safeguarding officer, or referring cases to social services and seeking advice, and that this came from the Director herself, Polly Carmichael:
“The Tavistock, like other NHS organisations, has a named person that clinicians can turn to to discuss specific safety concerns. That person is Sonia Appleby, but the transcripts allege that staff were discouraged from speaking to her by the director, Polly Carmichael.”
“There was a very clear message from senior management about being really cautious about how we talk to the safeguarding team. Specifically, Sonia Appleby.”
“I have had some consultations with Polly Carmichael about some of the young people I was seeing and some of the concerns I had raised and Polly very directly told me not to go to Sonia to share those concerns.”
We learned that Mrs Appleby could not comment as she had started legal proceedings against the trust last year. The Newsnight report suggests that the most vulnerable children are being put at risk.
“In the transcripts we have seen, clinicians were worried about the impact different kinds of abuse might have on young people trying to resolve questions about their gender identity. These could be seen as safeguarding issues.”
The Newsnight report revealed serious criticisms of individual staff members referring children to a medical pathway after inadequate assessment, in one case within the first hour of meeting:
“NHS England says that young people should be referred for medical treatment, puberty blocking drugs, after a minimum of three sessions. But the review heard from several staff that one member of the leadership, Sarah Davidson, would refer children for treatment after only one or two appointments.”
“I was working with an executive on one case of assessment of a young person and the executive member agrees to refer to this person to the medical pathway within the first hour of meeting him.”
This is in complete contradiction to the “cautious approach to treatment” that the Tavistock claims. According to the GIDS announcement of the Sinha review:
“A comprehensive psychosocial assessment precedes any referral to the endocrine clinic for consideration of physical treatments.”
We also know that the GIDS was alive to the issues of family pressure and acknowledges that often a push to transition comes directly from families:
“…We recognise that there are strongly held views among patients and families and their representatives including those who wish for physical treatment to be offered earlier…”
A serious cause for concern in the Newsnight report is that the complaints were not just about a few rogue clinicians, but extended to the Director of the GIDS herself, Polly Carmichael.
“In some of these cases clinicians thought it would not be appropriate for them to refer for puberty blockers but they would be overruled by GIDS director Polly Carmichael, the transcripts suggest.”
“The young person had clearly told me and my colleague that my mum wants the hormone more than I do and when we took to senior management, Polly Carmichael, she suggested that we refer. Even though this was not clinically indicated.”
“I kept saying to her, are we hurting children? And she did not say no. I kept saying to her, will we get sued and she did not say no. The only solace she gave me is she said it would not be me that would be sued, it would be Tavistock. She was not able to say to me that it is fine, we are not hurting the children.”
No-one from the Tavistock agreed to appear on the programme, instead issuing a statement about the Sinha review:
“We are confident that it fairly addressed the issues raised and strongly refute the allegations put to us by Newsnight”.
The Newsnight report claimed that the transcripts they had seen represent “a sizeable minority of the total number conducted with front line GIDS staff”. The worrying aspect of this is that the majority of staff did not raise these issues, issues relating to a culture of silencing and a management approach which should have been clearly visible to all.
The NHS Gender Identity service seems to view itself as the moderate middle ground between two warring factions of extremists (see this post). The fact is there are two groups, those who operate within the new gender ideology and those who don’t. Within the Tavistock there are clinicians from both sides. Sarah Davidson, for example, was involved with Gendered Intelligence and is a fervent believer in Queer Theory. At one Tavistock conference we attended Davidson urged us all to state our ‘preferred pronouns’ before speaking (nobody did).
Gender ideology demands the sacrifice of established knowledge, training and normal safeguarding protections in service of a belief in an innate gendered soul. Those outside the belief system can see it clearly and have been raising urgent concerns for years. Eventually though, those with conscience will leave the Tavistock, and only the ideologues will remain.
We were told in the report that 40 clinicians had left the GIDS within three years. As one ex-GIDS clinician told us “All the good people are leaving.”
The Care Quality Commission, who rated the GIDS system as ‘good’, has been working with Stonewall since 2012 as part of their Health Champions Scheme. The Tavistock and Portman NHS Trust is also a Stonewall Health Champion. While health institutions remain captured by the ideology of Stonewall, Mermaids and Gendered Intelligence, the homophobic parents consistently referenced by ex-GIDS clinicians can rest easy that their motivation for seeking ‘gender reassignment’ for their children will not be exposed.
“There have been many times when the push to transition has come from families who are uncomfortable with the sexual orientation of their child……some parents express real relief at their child is not gay or lesbian, suggesting being trans is a better outcome for their child”.
Following the Newsnight report there has been no outcry from Stonewall or any other ‘LGBT’ support organisation about this risk to gay and lesbian young people.
The Newsnight report confirmed that the Tavistock GIDS internal review failed to report or adequately address the serious safeguarding concerns reported by staff members and that their complaints extended to management. It is now time for a full investigation into what appear to be serious failings within the Tavistock GIDS current system. An external, independent review is urgently required before more vulnerable children are put at risk.