NHS Gender Identity Development Service

GIDS is a service provided by the Tavistock Clinic. Originally located at Tavistock Square in London, the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. However, it mainly focused on military psychology, including shell-shock, now termed PTSD. In 1948, with the creation of the NHS, the Tavistock Clinic launched its children’s department, which developed many works by Robertson and Bowlby on attachment theory.[1] In 1959, it opened an adolescent department and in 1967 absorbed in the London Child Guidance Clinic.[2] Following this, in 1989 the Tavistock Clinic established GIDS, the first and only service of its kind.[3]

Child and Adolescent Mental Health Services (CAMHS) provides the NHS support for children with mental health issues. However, CAMHS is organised by local government area and thus coverage varies significantly. The development of CAMHS within a four-tiered framework started in 1995. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy.

GIDS takes referrals from all mental health care professionals, especially Tier 2 and 3 CAMHS specialists. GIDS is distinct from CAMHS as is it is nationally run, not by the local authority. However, in the CAMHS framework it sits in Tier 4, as a highly specialised service.

In 1989 when the GIDS opened, "it got two referrals over the whole year."[4]

In 2009–10, 97 patients were referred to GIDS. By 2015–16, this had increased fourteen-fold to 1419 and in 2017–18 to 2,519. Due to reduced funding and increased referrals, the average wait time is two years from referral to first appointment.[5][6]

In 2011, the GIDS started introducing the puberty blocker drug in the "early stages of puberty" because of pressure from people who felt they needed to travel to America and to Holland to obtain the drug.[4]

In 2016, the waiting list for the clinic had increased to nine months.[4]

In 2016, the clinic was the subject of a Channel 4 documentary programme, told from the point of view of two satisfied trans children and their families.[4]

In November 2018, the parents of patients complained in a letter to the Trust board about the alacrity at which diagnoses were rendered, leaving them unable to intervene in these "life-altering decisions".[7] This led to the commissioning of an internal report by Dr David Bell, which concluded in February 2019 that the service was “not fit for purpose”, as children were being prescribed experimental drugs "after a few sessions and without proper investigation of their cases... under pressure from transgender rights groups". Bell urged the suspension of "all experimental hormone treatment for children who wished to change gender until there was better evidence of the outcomes."[8] Dr Marcus Evans, a member of the Tavistock and Portman NHS Foundation Trust governance board, resigned that week after a 35-year association with the T&P. He accused its management of having an "overvalued belief in" the expertise of GIDS, "which is used to dismiss challenge and examination."[9]

Subsequently to the Bell report it was revealed that 35 psychologists had resigned since 2016, including six psychologists who claimed there was “over-diagnosis” of gender dysphoria and a push for early medical intervention,[10] because "psychologists fear being branded transphobic."[11]

In February 2019, it was revealed that the National Institute for Health Research (NIHR) had announced a £1.3 million grant for a study following young people referred to GIDS, to compare mental and physical health outcomes for children referred. The study was to compare the effectiveness of different interventions, including psychological, endocrinological, pharmaceutical and alternative interventions.[9]

In July 2019, the Tavistock Centre was flooded which temporarily affected the IT servers at the clinic.[12]

In October 2019, a lawsuit was launched against GIDS by a mother of a patient at GIDS and Sue Evans, a nurse who formerly worked there.[13][14] Later, Evans passed their role as complainant to Keira Bell, a previous service user. In December 2020 following the High Court judgement, GIDS suspended all new referrals to endocrinology. The Court granted a stay on further implementation of the judgement until 22 December 2020.[15]

In December 2020 Dr Bell, a former governor of the Trust who was elected by the medical staff, and who had produced in February 2019 a damning report on the methods of the GIDS, reported that he now faced "disciplinary action" from the Trust.[8]

A 2019 Sky News report found that 35 psychologists resigned between 2016 and 2019. Six psychologists who resigned raised concerns about the over-diagnosis and medicalisation of young people experiencing gender identity difficulties. In February 2019, Tavistock trust member Marcus Evans resigned, citing similar concerns.[10][11] In July 2019, Kirsty Entwistle wrote a public letter about the GIDS service, saying professionals were often labelled “transphobic” if they raised doubts.[13][19] Clinicians have stated that concerns over children's welfare were "shut down".[20]

Following a letter to the board at Tavistock, an internal report was commissioned to look at the functioning of GIDS.[7] Dr David Bell authored the report which found that the service was “not fit for purpose”. It considered that the service could result in “damaging consequences” to children’s lives and failed to fully consider a child’s mental health background.[9] However, it did not identify any “immediate” issues with regards to safety and in 2018 the CQC rated the effectiveness of the Trust as “outstanding”.[21]

Conversely, there is a long wait time for a first appointment at GIDS, averaging at two years as of January 2020. GIDS blame high referral numbers and low staff numbers for this wait time.[22]

In October 2019, a legal complaint was lodged against GIDS at its satellite site in Leeds. The suit was brought by “Mrs. A”, a mother of a 15-year-old patient with autism, and Sue Evans, a former nurse at the Leeds GIDS satellite site. It alleges that advice around hormone therapy was “potentially misleading” and that true informed consent could not be given under such circumstances. The suit describes hormone therapy as “experimental” and states that there is “robust evidence” to show long-lasting medical effects of hormone therapy.[13][14] Some time after January 2020, Evans passed on her role as complainant to Keira Bell "who was prescribed puberty blockers by GIDS when she was 16. She had a double mastectomy aged 20, and now regrets transitioning, which has left her with 'no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered'. She may well be infertile as a side effect of the drugs."[23] In a judgment delivered on 1 December 2020, the judges said that it was 'highly unlikely that a child aged 13 or less would be competent to give consent to the administration of puberty blockers', and that it was 'doubtful that 14 or 15 year olds could understand the long-term risks and consequences' of this form of treatment. Where the young person is 16 or over, '...we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment.'[24] Immediately following the High Court judgement, GIDS suspended all new referrals to endocrinology. The Court granted a stay on further implementation of the judgement until 22 December 2020.[15] Amnesty International and Liberty issued a joint statement emphasising their concern on "the wider implications this will have on the rights of children and young people of all genders, particularly on consent and bodily autonomy."[25] Consortium issued a statement stating that the ruling "could have a potentially devastating impact on young people seeking access to medical services."[26] Leave to appeal against the decision of the High Court was granted in January 2021.[27]

The RCGP report on transgender healthcare in the UK found several flaws in the NHS approach. It called for a "whole system" change, including addressing waiting times and the lack of research around gender dysphoria in children.[28] The report noted the expansion of gender identity services into all four UK nations and "welcomes the forthcoming postgraduate diploma in Gender Identity Healthcare Practice." The report also noted that "in England, for example, GICs have seen a 240% overall increase in referrals over five years, with referrals to the Tavistock and Portman clinic alone increasing 8.43% between March 2018-19."[28]