The National Health Service (NHS) in England recently announced it will close the London-based Tavistock clinic, which has been used to treat Irish children and young people suffering from gender dysphoria under Ireland’s treatment abroad scheme. So what are the implications of the planned closure for transgender healthcare here?
What is the Tavistock clinic?
The Tavistock and Portman NHS Foundation Trust runs the only Gender Identity Development Service (GIDS) in Britain, which offers treatment to children and young people suffering from gender dysphoria, defined by the NHS as a “sense of unease that a person may have because of a mismatch between their biological sex and their gender identity”.
The specialist service provides puberty blockers, which can help delay potentially unwanted physical changes if a teenager is transgender. The Tavistock clinic advises that gender-affirming hormones, such as oestrogen or testosterone, can be prescribed to a trans teenager from the age of 16.
It has been providing an assessment service for Irish children and young people suffering from gender dysphoria. Some 234 young people in Ireland have been referred to Tavistock between 2011 and 2021, an average of 21 a year.
Why is it closing?
In September 2020, the NHS commissioned Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health, to conduct an independent review of the service.
In an interim report this February, Dr Cass found having a single national provider had become “unsustainable”, given the significant increase in referrals and growing pressure on waiting lists in recent years.
The report said it was clear that “a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand”.
The child health expert also said there were gaps in the evidence-base underpinning “all aspects of gender care for children and young people” in Britain, from assessment to diagnosis, support, counselling and treatment. Her report said the “most significant knowledge gaps” were around the use of puberty blockers and more research was needed in this area.
In a recent letter to the NHS, Dr Cass recommended the Tavistock clinic should be replaced by a number of regional centres.
What would those changes mean?
The proposed regional centres would offer a broad range of services to young people experiencing gender dysphoria. Dr Cass said this would allow for greater flexibility in responding to young people, to both those who go on to medically transition from one gender to another, and those who resolve their gender distress through other means.
The NHS has said it aims to have these regional services set up by next spring, as part of a planned transition away from a single national clinic.
How will this affect Irish children?
In Ireland if a child presents to a General Practitioner with gender dysphoria they can be referred to Child and Adolescents Mental Health Services (Camhs) which may then refer them to Tavistock.
The Health Service Executive (HSE) has said it is seeking to develop a domestic service but in the meantime will continue to refer children with gender dysphoria to the Tavistock clinic as the NHS moves to a new regional structure.
Dr Siobhán Ní Bhriain, HSE national lead for integrated care, has said the services offered by the clinic had not been deemed unsafe, and if they had the centre would have been closed immediately.
The HSE has said “in anticipation” of the Tavistock closure announcement it had also been exploring the availability of the service in other EU jurisdictions. The HSE is “working to develop this service in Ireland”, it added, and has “finalised the premises and allocated the multidisciplinary staff”.
The appointment of a consultant psychiatrist to manage the service is still required after being advertised twice without success, according to the HSE. “We are working on different options to resolve this problem and will continue to try and recruit appropriately trained staff to develop our own service in Ireland,” a spokeswoman said.
Do Irish medics have concerns about Tavistock?
Some Irish health professionals have expressed concern over the practice of referring young people to Tavistock.
Consultant psychiatrist Paul Moran, who works in the national adult gender clinic at St Columcille’s Hospital, Loughlinstown, Co Dublin, criticised the Tavistock clinic in internal HSE emails in early 2020. Dr Moran said he felt the service was “not capable of adequate assessment of suitability and readiness for hormone treatments or surgery”.
What do LGBT+ organisations say?
LGBT+ organisations have long criticised the lack of a gender identity healthcare service for children in Ireland.
Sam Blanckensee, chair of the Transgender Equality Network (Teni) said there was a need for additional resources to address current long waiting lists in Ireland. “There needs to be some service provided for those young people at the time that they need it,” he told RTÉ's Morning Ireland on Tuesday.