NHS England announces new model for 'safer' child gender services

NHS England has confirmed the establishment of six new regional centers aimed at supporting under 18s who are struggling with their gender identity. These centers, set to open over the next two years, will complement two existing clinics as part of a comprehensive reform of gender services for children and young people. According to the BBC, the new model prioritizes a holistic approach, particularly emphasizing mental health support and assistance for those with conditions like autism.

This initiative follows a recent ban on the routine prescription of puberty blockers for children experiencing gender dysphoria, mandated earlier this year. The changes are a response to the Cass Review, a critical assessment published in April by pediatrician Dr. Hilary Cass, which highlighted the need for enhanced psychological support. The review pointed out that many young people facing gender identity challenges also experience elevated rates of mental health problems and neurodiversity, including autism, ADHD, and trauma from childhood experiences.

Previously, the only NHS clinic dedicated to gender services for children was the Tavistock and Portman NHS Trust in London. This clinic faced scrutiny for relying heavily on medical interventions, such as the use of puberty blockers, without sufficient evidence of their efficacy. Its services were rated inadequate by inspectors in January 2021 before its closure in March.

In response to this overhaul, two new clinics opened in April in London and the north-west, operated in collaboration with prominent children's hospitals like Great Ormond Street and Alder Hey in Liverpool. The rollout of six additional regional hubs will commence this autumn in Bristol, followed by another opening in the East of England in March 2025. These clinics will also cater to children and young people from Wales, with Scottish ministers considering a similar model.

NHS England has outlined that GPs will no longer be able to refer patients directly to these clinics. Instead, referrals will need to come through children and young people's mental health services and pediatric specialists. This change aims to ensure a thorough assessment of the broader needs of these children before they are directed to specialized centers, responding to a significant rise in referrals in recent years. However, a proposal to restrict referrals until after age seven was ultimately discarded.

The care provided at the specialist centers will be monitored by a pediatrician or psychiatrist, incorporating insights from various specialists. Alongside mental health services and support for conditions like autism, the approach will focus on family involvement, including provisions for social care when family dynamics have deteriorated. Guidance on social transitioning will also be offered.

The regional centers will assist young people transitioning to adults who wish to access adult gender care services, which include hormone treatments and surgical options—though these services are also slated for review.

NHS England's medical director, Prof. Stephen Powis, stated that the new framework aims to establish a “fundamentally different and safer model of care for children and young people.” The organization anticipates that these changes will help alleviate lengthy waiting times, as indicated by a recent freedom of information request revealing an average waiting period of 100 weeks for 5,700 under-18s on the specialty care waiting list, with the youngest listed being under five.

Trials to assess the risks and benefits of puberty blockers are expected to commence in 2025. Dr. Cass expressed satisfaction with NHS England’s commitment to her recommendations, which have largely received support from the medical community. However, the British Medical Association (BMA) has criticized the ongoing ban on puberty blockers, with its leader, Prof. Phil Banfield, advocating for further improvements in care while acknowledging the clarity offered by the NHS announcement. The BMA is conducting its evaluation of the necessary provisions for gender services.