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We should be very grateful that Newsnight journalist Hannah Barnes has taken the time to think, to investigate, to interview Tavistock GIDS clinicians and write this important book.

It’s a gripping, riveting story. Even if you think you know everything already, there are more jaw-dropping revelations in here and reading the whole timeline of failings still shocks and disturbs.

‘Time to think’ is the rationale for giving children drugs to prevent or stall their natural puberty. It is the promise held out to children and their parents: blockers give a child time to think without experiencing the turbulence and distress of pubertal changes. It doesn’t take much thought to see that the premise is doubtful to begin with: how can a child truly understand their feelings about growing up to be a man or a woman without experiencing the processes of change during puberty and getting out the other side?

In fact, not surprisingly, puberty blockers seem to function to shut down thought and lock children into a medical pathway – only one of the 44 participants in the GIDS Early Intervention trial did NOT proceed to cross-sex hormones at age 16. Rather than time to think, perhaps what children need is time to grow.

Time to think is also what the clinicians working at the Tavistock did not have enough of, and the leadership team apparently failed to take, despite concerns being raised internally since 2005.

In fact if there is one overriding theme of this book it is the shutting down of thought, both in the counselling of children who were denied adequate opportunity to think more deeply about the reasons for their distress, and in the response to clinicians who dared to voice their concerns. In both cases, it is the concept of ‘transphobia’ that stalled thought at the Tavistock GIDS – whether a direct or implied accusation, the fear of being accused, or in some cases a truly-held belief. What happened at the Tavistock is a template of how a political ideology can prevent thought, exploration of concerns and open discussion: a template of failure in the safeguarding of children.

Hannah Barnes sensibly doesn’t get in to the wider political debates on this issue; she restricts herself to factual evidence and testimony from those who were actually there, and the book is the more powerful for that. The facts speak for themselves; Barnes leaves it to the reader to gasp in horror and make the judgments and analysis for themselves.

Barnes has set out the criteria for her account very clearly. This is a book that tells the story of the inside workings of the clinic and the wider Tavistock and Portman Trust; interviewees are only those who work or worked at the Trust or those involved in legal actions. It is not a story of the growth of wider activism and awareness-raising of the concerns, nor a political analysis.

This means that some of the major players in highlighting and bringing to public attention serious misgivings about the service are only referenced in strict relation to the story. Michael Biggs, for example, could have been given more credit for his pivotal role in discovering the cover-up of the puberty blockers study, eventually forcing the Tavistock to release the study data. The impact of Heather Brunskell-Evans’ and Michele Moore’s two ground-breaking books is covered, but not details of the threatened legal action from the Tavistock who demanded to read an advance copy in order to approve the second book Inventing Transgender Children and Young People. It took months of legal wrangling before Cambridge Scholars courageously decided to publish anyway.

Even the Newsnight episodes that Barnes produced are perhaps not given the prominent position they deserve in raising wider public awareness and forcing the Tavistock GIDS to publicly defend their service. But maybe all that is for another book – the full story is so big there are too many perspectives to tell. Restricting the narrative to very clear parameters makes for a coherent and credible account – the facts about what was going on internally are disturbing enough. It has also resulted in an invaluable written document of evidence that may be used to review practice at other gender clinics – or indeed other health services and more widely – to ensure that the terrible failings at the Tavistock are not repeated.

And what exactly were those failings?

To begin with, the extent of the GIDS’ involvement with the pressure groups Mermaids, GIRES and Gendered Intelligence right from the start is staggering. These are political campaign groups, two of which are run by parents, with very set ideas and beliefs based on the unscientific concept of innate gender identity. They are not politically impartial. As Mermaids became more politicised and extreme in their belief in gender identity ideology, so did the GIDS.

One of the most shocking things in the book comes in a long footnote about the treatment of the Bayswater parent support group. A thoughtful, engaged group of parents worried about the medicalisation of their children in the absence of adequate assessment and exploration, they were told in letters by Paul Jenkins and Paul Burstow that the Tavistock could not work with them because they promoted ‘actively transphobic’ groups on their website (including Transgender Trend who Polly Carmichael had previously recommended to a parent at the Emanuel Miller Memorial Lecture in 2018).

The evidence of the book shows that the grip of the ideology underpinning the demands of these groups only strengthened at the GIDS over the years. Language changed from ‘natal female’ to ‘assigned female.’ The clinic promoted Gendered Intelligence and the Genderbread Person (the GIDS conferences we attended over the years also reflected a service increasingly in thrall to gender identity ideology, with organisations like Gendered Intelligence, Allsorts and Intercom Trust given platforms to present their business models, and audience members invited to introduce themselves with their pronouns). In referral figures for 2021/22 the biological sex of 22% of children was not even recorded.

The pressure groups wanted one approach – gender affirmation – and one outcome: medical transition. And yet, as far back as 1996, themes of eating disorders, child sexual abuse, trauma and bereavement were being reported by clinicians from around the world; what was lacking was proper data and analysis. In 2002, in a clinical audit of around 124 referrals to the GIDS since the unit had opened in 1989, the evidence was there that the children referred to the service were far more complex cases than could be understood by one simplistic model.

This was a time when two thirds of referrals were boys, average age 11 at referral. Over 25% had spent time in care (compared to a rate of 0.67% for the general children’s population (2021)). 42% had experienced the loss of one or both parents through bereavement or separation. Only 2.5% had no associated problems; about 70% had more than five ‘associated features’ such as physical abuse, anxiety and school attendance issues. 42% suffered from ‘depression/misery.’ Close to a quarter of those aged 12 and over had a history of self-harming and the same percentage exhibited ‘inappropriately sexualised behaviour.’

Sue Evans, who was working at the service around the time of the audit says in the book “I didn’t come across simple cases.”

“Some had been sexually abused, she says, some were struggling with their sexuality, and some had suffered early traumas in their lives. Others were autistic or were being bullied in school.”

Evans’ concerns led to the commissioning of a report written by the medical director, Dr David Taylor. He found that:

“Many children referred to the service had suffered trauma, had mental health problems or had experienced ‘deprived or injurious upbringings.’”

The report recognised the pressure staff were under, from wider society but particularly from patient and parent groups which made it “very difficult for people to have freedom of thought.” Clinicians felt pressured to recommend the prescription of drugs more often and more quickly but there wasn’t an “overall Trust position to support them. They didn’t appear to be being supported to say ‘no’.” The report also recognised that puberty blockers were relatively untested and un-researched and questioned whether they were acting in the way they were intended. The report recommended long-term therapeutic input should be offered where possible, that there was a question around whether children were able to give fully-informed consent and that children on blockers should be followed up long-term.

The Taylor report remained hidden from the GIDS staff and the wider public for 15 years – Sue Evans never saw it – until (after a lengthy battle) BBC Newsnight obtained it through a Freedom of Information request. The GIDS largely ignored the recommendations. It did not provide extensive therapy before commencing puberty blockers, nor conduct regular audits, nor follow up these children and collect data. This first GIDS clinical audit was also its last. Barnes concludes this chapter with the blunt statement:

“Over the next decade and a half, more than a thousand children would be referred for puberty blockers, at ever younger ages.”

At the time of the audit and the Taylor report puberty blockers were only offered at age 16. Despite the evidence of the clinic’s own data, not only were concerns ignored but in 2011 the GIDS instigated the ‘Early Intervention’ puberty blockers trial and dropped the age to 12, then switched from an age restriction to Tanner Stage 2 of puberty (potentially age 9 or 10) and rolled out the treatment to children outside the study without having published the results.

The way this happened is detailed in Chapter 3 of the book ‘The Push for Puberty Blockers’ which ends with this chilling sentence:

“The NHS began medically altering the puberties of children, based on their declared identities.”

What is most inexcusable in this story is the fact that the failures of the early days of the service have simply been repeated down the years. The GIDS not only failed to take account of its own data, learn from it and put in place structures to ensure a safe service for children, it doubled down, allowing pressure from activists to dictate. The service became increasingly ideological, not less.

Exactly the same concerns detailed in the Taylor report in 2005 were repeated in a report by David Bell in 2018, which described the service as ‘not fit for purpose.’ Bell’s concerns were also echoed in a letter to the Trust’s board by a group of parents who were worried that their children were not being properly assessed. Bell was ordered not to share his report with the council of governors and subsequently faced the threat of disciplinary action until his retirement in 2021.

It took a service user who subsequently regretted her medical transition to alert a wider public to the serious harms of this treatment to the degree that the Tavistock GIDS and NHS England could no longer hide. Keira Bell (and Mrs A, the parent of an autistic teenage girl) brought a judicial review against the Tavistock in 2020 on the basis that children were not able to give fully-informed consent to puberty blockers. It was on the stage of the Royal Courts of Justice that all the concerns voiced by clinicians and whistle-blowers over the years were fully aired and, critically, supported by research and evidence. The Tavistock GIDS, by contrast, had none. The judges constantly expressed ‘surprise’ at the lack of data the GIDS’ legal team could present in defence of their case.

It was in the courtroom that the extent of the Tavistock’s arrogance and attitude of invincibility was exposed. Keira Bell won her case. It was a result the GIDS had clearly not expected.

“It did not appear that the prospect of losing had even been considered.”

Although the judgment was overturned at the subsequent appeal on the basis that it is for doctors to decide on the capacity of children to give consent and not the courts, the cracks in the service had been revealed. NHS England had announced a review of the GIDS in September of that year and Dr Hilary Cass published her Interim Report into the service in March 2022. NHS England subsequently announced the closure of the clinic and transference of services to regional hubs.

Why did it take so long? The GIDS could have listened to genuine and serious concerns over a decade ago and instigated change. All the warning signals were there. Instead they took the opposite route, lowering the age for puberty blockers and decreasing the number of appointments. Gender affirmation and medical transition became a standard pathway over the previous cautious approach of ‘watchful waiting.’ This, despite the sky-rocketing of referrals from 2015 onwards and a completely new population of children referred.

The treatment designed for a previous cohort of predominantly younger boys who had exhibited gender dysphoria since early childhood was simply transferred to a completely new population of majority teenage girls with no history of gender dysphoria in childhood, with no data or evidence to support it. Worse, this new population has an even greater incidence of pre-existing mental health issues, neurodevelopmental differences and troubled backgrounds, including an over-representation of children in care, and adolescents who are same-sex attracted (one of the most disturbing aspects of this book is the number of times homophobia is cited by clinicians as an area of concern.)

The Tavistock GIDS has still not provided exact data on the number of children prescribed puberty blockers. Barnes estimates from figures that are available that the majority of those referred in the 11 – 15 age group were referred on to the endocrinology clinic for blockers, peaking at 70% for 14 year-olds. The necessity to track outcomes expressed by GIDS founder Domenico Di Ceglie in 2002 has still not been realised.

Where was NHS England in all this? How did the Care Quality Commission judge the service ‘good’ in 2016 when the following year so many concerns were relayed to David Bell? A blunter question may be: why did the GIDS and the Trust not care enough about teenage girls, autistic, gay and troubled children to provide them with a service in line with normal standards of paediatric health care?

This book contains so much more than is outlined here. It should be read carefully by everyone involved in the care and safeguarding of children, including schools and government ministers. What other institutions are in thrall to transgender activists, leaving the most thoughtful professionals afraid to speak out? Where else do we see the same failure of safeguarding demonstrated at the GIDS? Why are the same ideological groups that influenced the GIDS allowed to influence policy in schools? Medical harm may be the most extreme result, but what other harms are being caused to children in schools, social care and child agencies by the failure to put facts and evidence ahead of ideology?

When will there be a public inquiry?

Our thanks to Hannah Barnes and to all the whistle-blowers and those who have spoken out and courageously tried to change things within the Tavistock GIDS and Trust over the years. This is a story that needed to be told. What happened at the Tavistock must never be allowed to happen again.