NHS plans autism and ADHD tests for children at gender clinics
Leaked plans suggest a move away from a purely medical model towards a more holistic approach to care. The London Standard's Daniel Keane explains what's behind the changes, how they link to the Cass Review, and the reaction from campaign groups.
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Telegraph
28-05-2025
- Telegraph
NHS orders clinic to stop prescribing cross-sex drugs to children
The NHS has ordered a GP practice to stop prescribing cross-sex hormones to children who want to change gender. WellBN GP surgeries in Brighton have flouted the Cass review's recommendations by prescribing the drugs to children, as first revealed by The Telegraph. The practice, which runs three surgeries, has been the subject of a legal challenge by the parents of Child O, an anonymous 16-year-old boy who claimed he was prescribed cross-sex hormones without having been properly assessed by a gender-identity clinic and without his parents' knowledge. WellBN said the NHS 'has forced us to temporarily pause initiating new NHS prescriptions for gender-affirming care to anyone under the age of 18', including a ban on taking on prescriptions from private sector providers. The administration of cross-sex drugs, also known as gender-affirming hormones, involves giving hormones such as testosterone to help someone change their physical appearance. They are different to puberty blockers, which stop the onset of puberty by suppressing the release of hormones. The Cass review, led by the paediatrician Baroness Hilary Cass, said all under-18s questioning their gender should be seen by a team of experts for a range of conditions including mental health issues and neurodevelopmental disorders such as autism. The independent review concluded that medical pathways to change genders had been ' built on shaky foundations ' and called for puberty blockers to be banned, citing the 'weak evidence' to support their use in this group of patients. It urged 'extreme caution' in relation to cross-sex hormones. However, WellBN GP has continued to prescribe cross-sex hormones to patients such as Child O, allegedly after minimal consultation. The practice has also allegedly continued to take on prescriptions from private providers whose checks are less robust than the NHS. The parents of Child O allege the GP had prescribed the drugs without their knowledge, in spite of him suffering from mental health issues for most of his life. They also claim that his school had facilitated his 'social transitioning', which is when someone changes their name and way they dress in alignment with their preferred gender, without pursuing medical treatments. Paul Conrathe, a senior consultant solicitor at SinclairsLaw who is representing Child O's father, said the intervention was 'long overdue'. 'This surgery has been providing a highly controversial life-altering treatment without following the recommendations of the Cass review or cautious guidance of the NHS,' he told The Telegraph. 'Patients now need to be moved into appropriate specialist treatment as soon as possible. Activist medicine should have no place within the NHS.' The practice uses an 'informed consent' model – discredited by Lady Cass's review – which gives patients, including children, information about the cross-sex drugs and side-effects to inform their decision. Critics claim this approach does not further look into possible causes to want to take cross-sex hormones or whether there are other issues, critics claim. 'Should refuse' children NHS England previously wrote to GPs telling them they 'must refuse' requests to prescribe puberty blockers because it is a criminal offence and 'should refuse' cross-sex hormone requests to children unless carefully considered. The trans health hub team at WellBN said NHS England and NHS Sussex did this 'by threatening to close us down altogether if we did not comply' in a letter addressing its patients. 'We are waiting to have a meeting with NHS Sussex to discuss this, and we will do our best to turn this decision around,' the update said. 'We will continue to prescribe to young patients who are already under WellBN's care and/or for whom we have already overtaken private prescriptions – the demand is specifically in relation to the initiation of new prescriptions.' It said it had to consider the health of its 25,000 patients, including 2,000 transgender and non-binary patients. The practice told patients they could 'still have a comprehensive trans health review' at their clinics with a 'supportive and affirming clinician'. It also said they would be able to 'discuss HRT [hormone replacement therapy] with you'. The letter was signed off 'with solidarity and rage' from the team. Stephanie Davies-Arai, the director of Transgender Trend, said there was 'a strong school-to-clinic pipeline established in Brighton'. 'Children are thoroughly indoctrinated in schools and then referred on to the WellBN clinic for hormones. The clinic has been unsafely prescribing cross-sex hormones to minors in breach of the Cass review recommendations and NHS guidelines for some time,' she said. 'NHS England should step in much earlier to prevent these ideological practitioners from harming children.' Keith Jordan, the co-founder of Our Duty, a support and advocacy group for parents with gender-questioning children, welcomed 'the increased NHS scrutiny of those prescribing cross-sex hormones to adolescents'. 'Clinics that provide treatments based on ideology and not clinical need require closing down. We maintain that young people cannot provide truly informed consent for such irreversible interventions due to their developmental stage and the complexity of long-term consequences,' he said. Lasting effects Last week, the Government announced that it was launching a review into the prescription of cross-sex drugs following the threat of a judicial review. Experts will analyse the available evidence and recommend a decision in July, officials said, raising the prospect that the drugs could be outlawed for children in the UK, like puberty blockers. It is understood two clinical reports led by experts in Sweden and Finland caused Wes Streeting, the Health Secretary, to order the review, according to a report in The New Statesman. The new evidence specifically raised concerns about the impact of starting cross-sex hormones under the age of 18, finding that years of treatment 'will increase the risk of cardiovascular disease', stroke, 'decrease fertility, impair liver function and increase the risk of cancer'. An NHS spokesman said: 'NHS England and Sussex Integrated Care Board have jointly acted in response to concerns about the inappropriate prescribing of hormone treatment to children and young people. 'The NHS clinical policy for masculinising or feminising hormones follows the recommendations from the independent Cass review that these hormones should only be prescribed with extreme caution from the age of 16.'
North Wales Chronicle
15-05-2025
- North Wales Chronicle
Rise in children's gender care waiting list across England and Wales
Average waiting times have also grown to more than two years for a child to get a first appointment at a specialist NHS clinic. There were 6,225 children on the national waiting list at the end of March – up from 5,560 at the same point a year earlier, data obtained by the PA news agency showed. The British Psychological Society said the numbers show that 'demand is currently outpacing supply' and warned it is 'essential' for children to get professional care and support 'before they reach crisis point'. Health Secretary Wes Streeting last year branded waiting times 'unacceptable', acknowledging the 'enormous distress' they can cause. Responding to the latest figures, NHS medical director for specialised services Professor James Palmer said he understands it 'can be really difficult' for children and their families waiting to be seen. Two children's gender hubs, led by London's Great Ormond Street Hospital (Gosh) and Alder Hey Children's Hospital in Liverpool, opened in April 2024. This followed the closure of the Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust. A third service has since opened Bristol while another is planned for the East of England 'later this spring', according to the Department of Health and Social Care (DHSC). The aim is for there to eventually be up to eight specialist children's gender clinics covering the seven NHS regions in England. Of those on the national waiting list – which covers England and Wales because the latter does not have its own dedicated children's gender clinic – 157 children were aged under 10, according to a Freedom of Information request by PA. Fewer than 10 children were aged under five years old, NHS England said, adding that it would not give an exact number as this could breach confidentiality because of people being potentially identifiable in smaller groups. There is no minimum age requirement for gender care, with the NHS previously saying they want to ensure parents of very young children are given support where necessary. Waiting times for a first appointment have also risen, to an average of 116 weeks at the end of March from an average of 100 weeks at the end of May last year. Dr Roman Raczka, president of the British Psychological Society, said: 'It is essential that children, young people and their families can access the professional care and support they need, before they reach crisis point. 'Demand is currently outpacing supply. This contributes to a range of broader challenges which face children and young people's services that require further investment.' Some 250 patients transferred from Gids have been seen by new services, and it is understood each of the new clinics is designed to see 25 patients a month. Following the Cass Review last year which concluded children had been let down by a lack of research and evidence on medical interventions in gender care, NHS England announced a new plan which requires new referrals into the clinics to have been seen by a GP and mental health specialist or paediatrician first. Guidance expected to be published later this month will see the health service move away from a 'medical model' in favour of a 'holistic' approach to children's gender care, as per recommendations from the Cass Review. According to leaked plans reported last month, children who have gender dysphoria will be tested for neurodevelopmental conditions including autism and ADHD (Attention-Deficit/Hyperactivity Disorder). Prof Palmer said: 'We know it can be really difficult for children and young people and their families who are waiting to be seen by our new holistic gender services, and that's why it has been so important that we put a new system in place to ensure that, while they're waiting, they can access mental health support if they need it. 'The NHS is now almost halfway through its planned expansion of regional services, and we are seeing significantly fewer referrals as children are first assessed by paediatric or mental health experts and provided with care in NHS services that are more appropriate to their needs.' Puberty blockers are not prescribed on the NHS to children for the treatment of gender dysphoria, after a ban last year was made permanent in December with the agreement of devolved governments across the UK. Plans remain in place to set up a clinical trial into the use of puberty blockers this year, although no patients have yet been recruited while ethical and regulatory approval is awaited. A DHSC spokesperson said: 'We are working with NHS England to reform children's gender services in line with the recommendations from the Cass review, to provide children with timely, holistic support. 'We've opened three new children and young people's gender services with a fourth anticipated to open later this spring. These new services will increase clinical capacity and reduce waiting times, so patients can be seen sooner and closer to home.'
Leader Live
15-05-2025
- Leader Live
Rise in children's gender care waiting list across England and Wales
Average waiting times have also grown to more than two years for a child to get a first appointment at a specialist NHS clinic. There were 6,225 children on the national waiting list at the end of March – up from 5,560 at the same point a year earlier, data obtained by the PA news agency showed. The British Psychological Society said the numbers show that 'demand is currently outpacing supply' and warned it is 'essential' for children to get professional care and support 'before they reach crisis point'. Health Secretary Wes Streeting last year branded waiting times 'unacceptable', acknowledging the 'enormous distress' they can cause. Responding to the latest figures, NHS medical director for specialised services Professor James Palmer said he understands it 'can be really difficult' for children and their families waiting to be seen. Two children's gender hubs, led by London's Great Ormond Street Hospital (Gosh) and Alder Hey Children's Hospital in Liverpool, opened in April 2024. This followed the closure of the Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust. A third service has since opened Bristol while another is planned for the East of England 'later this spring', according to the Department of Health and Social Care (DHSC). The aim is for there to eventually be up to eight specialist children's gender clinics covering the seven NHS regions in England. Of those on the national waiting list – which covers England and Wales because the latter does not have its own dedicated children's gender clinic – 157 children were aged under 10, according to a Freedom of Information request by PA. Fewer than 10 children were aged under five years old, NHS England said, adding that it would not give an exact number as this could breach confidentiality because of people being potentially identifiable in smaller groups. There is no minimum age requirement for gender care, with the NHS previously saying they want to ensure parents of very young children are given support where necessary. Waiting times for a first appointment have also risen, to an average of 116 weeks at the end of March from an average of 100 weeks at the end of May last year. Dr Roman Raczka, president of the British Psychological Society, said: 'It is essential that children, young people and their families can access the professional care and support they need, before they reach crisis point. 'Demand is currently outpacing supply. This contributes to a range of broader challenges which face children and young people's services that require further investment.' Some 250 patients transferred from Gids have been seen by new services, and it is understood each of the new clinics is designed to see 25 patients a month. Following the Cass Review last year which concluded children had been let down by a lack of research and evidence on medical interventions in gender care, NHS England announced a new plan which requires new referrals into the clinics to have been seen by a GP and mental health specialist or paediatrician first. Guidance expected to be published later this month will see the health service move away from a 'medical model' in favour of a 'holistic' approach to children's gender care, as per recommendations from the Cass Review. According to leaked plans reported last month, children who have gender dysphoria will be tested for neurodevelopmental conditions including autism and ADHD (Attention-Deficit/Hyperactivity Disorder). Prof Palmer said: 'We know it can be really difficult for children and young people and their families who are waiting to be seen by our new holistic gender services, and that's why it has been so important that we put a new system in place to ensure that, while they're waiting, they can access mental health support if they need it. 'The NHS is now almost halfway through its planned expansion of regional services, and we are seeing significantly fewer referrals as children are first assessed by paediatric or mental health experts and provided with care in NHS services that are more appropriate to their needs.' Puberty blockers are not prescribed on the NHS to children for the treatment of gender dysphoria, after a ban last year was made permanent in December with the agreement of devolved governments across the UK. Plans remain in place to set up a clinical trial into the use of puberty blockers this year, although no patients have yet been recruited while ethical and regulatory approval is awaited. A DHSC spokesperson said: 'We are working with NHS England to reform children's gender services in line with the recommendations from the Cass review, to provide children with timely, holistic support. 'We've opened three new children and young people's gender services with a fourth anticipated to open later this spring. These new services will increase clinical capacity and reduce waiting times, so patients can be seen sooner and closer to home.'
