The review also found the clinic did not have consistent data collection,which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service;there was lack of open discussion amongst staff about the appropriate clinical response;and because the specialist service had evolved rapidly in response to demand,the clinical approach and overall service design had not been subjected to usual quality controls.
On face value,and without taking the time to read the review,it would be easy to interpret this as a condemnation of children’s gender clinics in general. However,I submit that this is not an accurate evaluation.
The most compelling statement inDr Cass’s interim review was that the Tavistock clinic was failing in its prime objective – to see young people in a timely fashion and assess their needs regarding gender. The major issue was the unacceptable time young people languished on the up to two-year waiting list.
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There has indeed been a large increase in the number of young people being referred to gender clinics worldwide (the number of referrals to Tavistock jumped from 250 to 5000 over a decade to 2021). There are several reasons for this,including greater trans visibility,increased societal acceptance and awareness of gender diversity,and consequently better recognition and understanding by young people of their own gender identity. The single specialist provider model of the Tavistock clinic,overwhelmed and underfunded,cannot hope to meet this demand or serve its clients well.
In her review,Dr Cass recommended a fundamentally different service model – one that is decentralised and has multiple local and regional hubs,with strong links to local services,such as mental health and GPs. This represents an expansion of gender services,and signals a positive shift in how the NHS will deliver services to trans youth.
This decentralised model of care is already being adopted in various states in Australia,including Queensland,NSW and Victoria – in other words,we are already doing what Cass has recommended. An example is Maple Leaf House in Newcastle,a multidisciplinary service for trans youth,affiliated with John Hunter Hospital.