Great Ormond Street Hospital advisers quit new NHS children's gender clinic 'over concerns that staff are being trained to offer an affirmative approach to young patients over trans treatment'

Advisers brought together to agree guidelines for new gender clinic in LondonReports suggest team was split over whether to recommend 'exploratory' careREAD MORE: Dozens of under-5s to NHS transgender service

Advisers working at a new NHS children’s gender clinic in Great Ormond Street Hospital (GOSH) reportedly quit after disagreeing with plans to train staff to offer ‘affirmative’ care to young people with gender dysphoria.

The team of experts, including paediatricians and child psychologists, was tasked with agreeing key training materials for the hospital’s new gender unit – one of two to replace London’s Tavistock Gender Identity Development Service (GIDS).

But reports suggest the group could not agree on the direction of the materials , amid claims they were not following the independent recommendations made by Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health.

The Cass Review of NHS gender services for children concluded last year the single Tavistock service was ‘not sustainable’ given a rise in referrals and that there was a ‘lack of consensus and open discussion about the nature of gender dysphoria’.

It also expressed concern about the ‘affirmative, non-exploratory’ approach to care offered at GIDS often driven by the fact a child had started to ‘socially transition’ – changing their name, using new pronouns – while waiting for an often-delayed referral to the service.

Great Ormond Street Hospital in London is to host one of two new children’s gender clinics

The GOSH service is one of two to replace the Gender Identity Development Service (GIDS) at London’s Tavistock Centre

Dr Hilary Cass, who led a review into the NHS’ child gender services that led to the closure of GIDS at Tavistock

Several members of the GOSH taskforce disagreed with the findings of the Cass Review, reports The New Statesman — and this led to a clash with others who believed they should be adhered to by offering an ‘exploratory’ approach to care.

At least four of the 11 on the advisory team, including its manager, walked away at the end of last year, according to the Telegraph.

It echoes findings in the Cass Review on GIDS, which found that ‘many individuals who are more cautious and advocate the need for an exploratory approach have left the service.’

The review added: ‘With respect to GIDS, we have been told that although there are forums for staff to discuss difficult cases with senior colleagues, it is still difficult for staff to raise concerns about the clinical approach.’

The work has now been passed to the Academy of Medical Royal Colleges, which told the paper that ‘time is tight’ to prepare the guidelines for staff at the GOSH service, but said it was ‘keen to help’.

GOSH, meanwhile, said it had ‘wrapped up its part of the process, having produced a range of high-quality materials’.

‘The programme has now been passed on to the Academy of Medical Royal Colleges, who will complete and deliver the induction programme, a spokesperson said.

Last year, the hospital said it was recruiting a ‘wide range of people to the roles of education leads, to collectively develop the materials in line with the Cass Review recommendations.’

A statement issued by GOSH in April last year, as the taskforce was launched, continued: ‘While we appreciate they may hold differing views, there will be strong governance processes in place to ensure the curriculum aligns with both the Cass Review, the interim service specification and all available evidence.’

Great Ormond Street is one of two ‘hubs’ that will replace Tavistock in providing children’s gender services on the NHS in England.

Its services, for the south, will be run in partnership with Evelina London Children’s Hospital, part of Guy’s and St Thomas’, and the South London and Maudsley NHS Foundation trust.

The ‘northern hub’ will be formed of a partnership between Alder Hey Children’s NHS Foundation trust and the Royal Manchester Children’s Hospital.

Demand for children’s gender services is at an all-time high; more than 6,000 children are on the waiting list, and thousands of referrals were made to GIDS last year, up from 250 referrals in 2011/12.

Some 2,000 children who were on the waiting list for child services have now been referred onwards to adult services, having waited so long they would turn 18 before they were seen.

The Cass Review claimed around one-third of those referred to the service have autism or another form of neurodiversity, while a significant number were also care-experienced.

While it did not include ‘definitive advice on the use of puberty blockers’ – which can be used to delay the onset of puberty while a child is considering their gender identity – the NHS has imposed a de-facto ban on the use of the drugs in treatment.

Instead, they will only be given to those with ‘early-onset gender dysphoria’ in an NHS-commissioned research study.

The NHS itself said prior to the new rules coming in that child GIDS treatments tended to involve psychological therapies rather than medical interventions such as the use of puberty blockers because ‘because in many cases gender variant behaviour or feelings disappear as children reach puberty’.

Critics of the NHS guidelines produced in response to the Cass Review include the gender charity Mermaids, which said they would ‘restrict, pathologise and undermine access to care’.