“Drown in the middle”
For young people already in the system, the NHS has said that care at the Tavistock Clinic will remain unchanged from before its closure. NHS documents reviewed by Reuters show that despite growing waiting lists, only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year.
Staffing has also dipped as many psychologists have left or, like Kelly, entered private practice. Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.
Two people familiar with the plans said the deadline for closing the clinic has also been pushed back to the end of June 2023 at the earliest, although the NHS is still aiming to open two new sites in spring next year, with a further seven Will follow. Those who have been waiting the longest will be given priority.
A spokeswoman said the NHS was also working on a system to deal with the backlog and improve support for those on the new list.
But practitioners say polarized views around gender care will make staffing challenging.
“People who have gender-critical views call you a child abuser and a monster, and then there are a lot of angry families who accuse you of gatekeeping. And you’re just drowning in the middle of it all,” Dr Laura Charlton , a clinical psychologist who left Tavistock in 2020 after six years and now only treats adults.
The gender-care reform became further embroiled in political turmoil after Prime Minister Boris Johnson resigned in September. Both his successors, Liz Truss and Rishi Sunak, earlier this year voiced their opposition to the use of “irreversible” measures for transgender youth.
Neither Truss nor Sunak’s office responded to a request for comment for this story. Sunak has said that people under the age of 18 should be protected from “life-changing treatments”.
In September, a few weeks after Truss was in office, the NHS briefly posted a draft of proposed new treatment guidelines on its website, then removed them. The guidelines were reissued on 20 October, the night Truss resigned.
A Reuters review of the original draft suggests that key passages had been changed by the time they were reissued.
Both versions of the guidelines say that only medical professionals can refer young people to gender care, and call a meeting between clinicians before adding a child to the waiting list. They say the new clinics will be headed by medical doctors rather than psychologists.
The guidelines also say that young people who, like Miles, receive drugs from providers that are not regulated in the UK should be referred to local authorities – such as the police and social services – once the NHS decides on their case. takes it
The NHS has separately said it will only prescribe puberty-blocking drugs for transgender adolescents “within the context of a formal research protocol”. It did not specify how the gender-affirming hormones would be determined, although it also suggested enrolling young people in the clinical trial in the future.
However, revised guidelines state that instead of relying on the adolescent’s statements, adolescent patients will need to have a gender dysphoria diagnosis from a specialist clinician before their social transition can be supported by the NHS.
Two people involved in the process said the changes around social distancing appeared to have come after the draft was sent through government approval processes within the Department of Health and the Prime Minister’s Office, rather than the NHS or gender experts.
For public servants not to recognize a young person’s preferred gender identity without a medical diagnosis would be contrary to the way gender-affirming care is delivered in England and globally. People briefed on the matter said the proposed requirement was not supported by doctors involved in the CAS review. There was no such requirement for social change in the original draft.
The draft plan has been criticized by medical groups specializing in transgender health around the world.
WPATH, along with several affiliated regional and national groups, said in a statement in late November, “This … represents an unconscionable degree of intrusion into … everyday matters such as clothing, names, pronouns and school systems.” ” ,
The president of WPATH and a penis surgeon in the United States, Dr. “We’ve spent 20 years trying to reduce barriers to care. And now we’re seeing barriers,” Marcy Bowers told Reuters in response to the NHS guidelines.
Spokesmen for the Department of Health and the Prime Minister’s Office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.