[Music]
the gender identity development service
at london's tavistock and portman trust
is england's only nhs specialist service
for young people questioning their
gender identity
in june newsnite revealed that serious
safeguarding concerns have been raised
by some staff at jids
during an official review in 2019
we've now learned that some of the
worries voiced during that review were
not new
they go back 15 years there had been
another review of the service in 2005 by
the trust's then medical director
dr david taylor it was triggered by a
nurse working at the unit sue evans
she was troubled about what she was
seeing my experience of working
with most of the young people was that
once you
assess them and found out more about
them they had complex backgrounds it
wasn't just the gender dysphoria
they some of them had been sexually
abused some of them had been traumatized
in their earlier life
early separations some had autism
there were other clinicians who seemed
confident that they could
see someone for about four to six
sessions and then refer them on
for hormone treatments and i just
couldn't understand that
a satisfactory assessment or any attempt
at therapeutic work
had been carried out newsnight has
obtained a copy of that 2005 review
dr taylor stresses that staff were doing
all they could to help the patients who
were often very distressed
but his report went on to detail several
areas
he believed needed addressing he noted
that
many children referred to the service
had suffered trauma or have mental
health problems
staff face pressure to comply with
demands from patients
and their parents to be referred for
puberty blocking medication
there wasn't a robust evidence base
underpinning this treatment
and staff disagreed about the best way
to treat these young people
the implications for this are that young
people might not have had other issues
addressed
before making a potentially
life-changing decision to go on to
puberty blocking drugs
these concerns are strikingly similar to
those raised by staff in recent years
the service was much smaller in 2005
receiving tens of referrals rather than
thousands
and did not contribute significantly to
the tavistock trust's finances
young people had to be 16 before
referral for puberty blockers
now they can be as young as nine and yet
there are still questions about the
evidence base
the findings of the 2005 review have
never been made public
and getting sight of them hasn't been
easy in may
2019 newsnight requested a copy of dr
taylor's review
using the freedom of information act the
tavistock declined arguing
its disclosure could adversely impact on
the trust's ability to
provide effective and safe services to
its patients
we appealed in july 2019 and when
refused again
went to the information commissioner's
office in october
in august 2020 the ico ruled that it was
in the public interest to disclose the
document
saying patients prospective patients and
their families
should be able to see this information
we received the report
a few weeks later the recommendations
made by dr taylor were in his words
not rocket science he says they reflect
core principles of clinical practice and
could be applied to any part of medicine
he called for the service to follow up
all its patients
for more research in this area of
healthcare and for staff to be supported
if they came under pressure to refer for
a treatment they thought was
inappropriate
dr taylor said that puberty blockers
might be an appropriate course of action
for some
but all young people needed exploratory
therapy first looking at the report
today that was written 15 years ago
in those years the missed opportunity
for me is that
dr taylor recommended there should be
clinical audit
better understanding developed of gender
dysphoria in young
people research should be
woven into the work of the clinic
and i really don't think listening to
the more recent reports about the clinic
i i really can't
hear that that has gone on sufficiently
last year evans initiated judicial
review proceedings against jids
arguing under 18s cannot give informed
consent to puberty blockers
when not enough is known about what they
do
the trust is contesting the case it'll
be heard next week
the perception that jids could have done
things differently has angered some
staff
dr kirstie entwistle left judd's leads
in 2018
she's not spoken publicly before but is
a witness against the service in the
upcoming judicial review
i left the service kind of wondering
why me like why did i have like such a
strong reaction
and and then you know it takes all this
time and i find out that there's all
these clinicians in london who
had the same concerns as me and and then
you find out well actually
you know people have been having these
concerns about the service for years you
know
just seems like it's more convenient
just to plow on
because i think the concerns that people
are raising you know
require a fundamental reorganization or
a fundamental
rethink of what's going on here
dr taylor a psychiatrist who worked at
the tavistock for 30 years
wrote in his review that some of what
he'd suggested
would likely be resisted by some
patients and patient organizations
he recognized that this could lead to a
fall in referrals
if you try to set out to please
or comply with someone
whether you're a parent or a clinician
then you won't be helping them
it's very important that you keep
an independent perspective but i do
think that maybe
the service as it developed to some
extent
lost its compass in those respects
so why would his reviews recommendations
implemented
there isn't one easy answer the demand
for these services was greater than the
capacity of the unit
to cope to cope by
maintaining its standards
of thoughtful mental health care which
considers all the factors
biological and social and he says
the setting in which the service was
working society's shifting attitudes
towards gender identity
and the lack of alternative provision
are also important
many patients would have been better
served
referred to other services but under
funding of child and adolescent mental
health
services made that impossible
over the last 14 months newsnight has
looked at the uncertainties about
treatments given to young people
questioning their gender identity we've
also revealed
allegations that safety concerns weren't
taken seriously enough
last week the nhs announced an
independent review into gender identity
services for young people
i think that's a very very good
development and entirely the right way
forward and because those
those reviews are arenas that are more
public
in which the kind of discussions and
debate
that we are talking about can go on
fifteen years after dr taylor's report
key issues at the heart of service
provision for young people
questioning their gender identity are
still being debated
the question now is will this review
bring some resolution
so newsnight put the issues raised in
their report to the tavistock who
responded by saying this report from
2006 is not
relevant to the circumstances and issues
faced by jids that's the gender identity
development service
today they continued while the demand
for the jid service has increased
markedly since 2006
each young person does receive a highly
personalized service from jid's
clinicians
though we're sorry that this is now
delivered after a longer wait than we'd
like
it has recently been announced that dr
cass will lead a wider review of the
care provided to gender questioning
young people
we welcome this and hope this will lead
to better and quicker access to support
for these young people some of the young
people we see in the service experience
difficulties which may or may not be
related to gender dysphoria
jids is a specialist service and relies
on integrated care model
in which it works closely with local
cams to support ongoing difficulties
it's important to recognize that not all
co-occurring difficulties
will be resolved by accessing specialist
psychosexual
exploration of gender identity and
related issues