How the void left by the Tavistock is being filled by the private sector

tavistock

When Susan Evans scrolled through the staff page for Gender Plus, the private gender assessment and hormone treatment clinic licensed by the Care Quality Commission (CQC) in January, she was immediately met by familiar faces. “A large proportion of these people I recognised from working at the Tavistock,” she says.

Evans, a psychotherapist who joined the Tavistock in 2003, was one of the first whistleblowers at the Gender Identity Development Service (Gids), the nationally operated clinic which was disbanded two weeks ago after more than 30 years. She had found the CQC’s decision to licence Gender Plus – which is led by Dr Aidan Kelly (a clinical psychologist who worked at the Tavistock from 2016 to 2021) and staffed by several other former Gids employees – “strange”.

Particularly, she says, “given that we were only three or four months away from the Cass Review final report and given what her first report already said”. The CQC says new services are checked to ensure they are “safe, effective, caring, responsive, and well led”.

But the interim review had deemed Gids “neither safe nor viable”; the final review laid out how children had been let down by a lack of research and “remarkably weak” evidence on medical interventions. Evans’s main concern? That this new clinic, based in east London, would become a canary in the coalmine for clinicians wanting to fill the void left by the Tavistock.

Susan Evans, pictured with husband Marcus, was one of the first to voice concerns about the Gender Identity Development Service – Julian Andrews

With young people now unable to turn to the NHS for unfettered gender treatment (NHS England has put an end to the routine prescription of puberty blockers), those who could afford it would surely turn to the private sector and online services not subject to NHS directives. Gender Plus is just the beginning, she says. “I think there will be more.”

In fact, some say there already are. Though Gender Plus is the only licenced clinic and doesn’t prescribe puberty blockers (though it does have a hormone clinic that sees over 16s for “gender affirming hormones” – an age group Dr Hilary Cass identified in her review as being in need of ongoing care up to the age of 25), Tavistock whistleblowers say they have heard from parents who claim that their children are accessing treatment elsewhere.

Evans recently heard from one parent about “a GP operating down in Brighton who is writing prescriptions for young adults”. “I’m also aware there’s someone in Harley Street who is waving people through to surgeries and hormones without the care and assessment that is required for something so serious.”

Earlier this year, GPs in south London were warned by the NHS not to work with one particular clinic. They were issued an alert telling them not to prescribe puberty blockers or cross-sex hormones on the advice of GenderGP. The clinic is registered in Singapore so is not regulated in the UK, but in 2022 it claimed 800 under 18s in the UK were on its books. At the time, GenderGP said: “Gender-affirming care saves lives and absolutely needs to be accessible for trans people of all ages.”

GenderGP’s founder, Dr Helen Webberley, who has previously described herself as Britain’s only private doctor treating transgender children, has prescribed testosterone to a patient as young as 12.

Dr Helen Webberley, founder of GenderGP, pictured in 2023 at the Royal Courts of Justice, where she was appealing a decision to suspend her from practice – Jordan Pettitt/PA

Alleged “loopholes” provided by clinics like GenderGP “need government action”, says Stephanie Davies-Arai, founder of Transgender Trend, which campaigns for evidence-based healthcare.

“They need to be shut down. It’s fine to have private clinics but if you’re offering treatment that is outside NHS guidelines then you are putting patients at risk.”

Young people and their families will turn to private practitioners, Davies-Arai says, “because parents who can afford it who think this is the right thing will be desperate”.

Dr David Bell, another Tavistock whistleblower, worries for parents who feel pressured to take children to private clinics where they will “continue to be damaged”. It’s the “attitude” of clinicians in private practices that particularly concerns him. “The attitude of the gender clinics is to affirm. So that means that if a girl comes in and says I can’t stand my girl body anymore, you need to help me change into a boy, the wrong treatment is to affirm that. That’s taking an ideological position, not a clinical position. They’re continuing to affirm and that’s wrong.”

The Tavistock clinic’s Gender Identity Development Service was closed in 2022 – Dan Kitwood/Getty

Marcus Evans, husband of Susan, and a consultant psychotherapist who quit the Tavistock over his concerns about the service, claims people who have gone from Gids to private clinics are “ideologically driven”. He feels the model at private clinics is “wrong”.

“It’s just not a clinical model,” says Evans. “It’s a clinically irresponsible state of mind.”

Private clinics offer a “consumer choice” rather than a medical safe haven, claims Evans, who worries staff who have “just decamped into the private sector” will bring with them the dysfunction the Cass Review exposed. “They’re not going to listen to any evidence. The service hasn’t done for the past 18 years and they won’t now.”

Gender Plus says it welcomes “many aspects outlined in the Cass Review”.

“Gender Plus is already working in line with much of what is described in the Cass Review,” its director, Dr Kelly, said in a statement. “We offer a careful multi-disciplinary team approach to our assessment and ongoing support of young people.

“We offer both mental health and neurodevelopmental assessment and support, alongside the gender work. Our hormone clinic sees only those 16 years or older for gender affirming hormones, it does not prescribe puberty blockers.”

Evans fears licensing one clinic constitutes “opening the door for others”.

“Apart from anything else, there is money to be made and there’s no shortage of kids that will go privately if there is that route available,” he says. “It’s one licence at the moment, but it could be many if this gap isn’t stopped.”

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