NHS to test all ‘trans' children for autism
The NHS will test all children who believe they are transgender for autism under new plans seen by The Telegraph.
Every child referred to a gender clinic will be 'screened for neurodevelopmental conditions' such as autism and ADHD under new guidance, to be introduced in the wake of the Cass review.
The review, by paediatrician Baroness Cass, found that the mental health conditions were disproportionately common among children and young people with gender dysphoria.
Medics will also evaluate each child's mental health, their relationship with their family and their sexual development, including whether they are experiencing same-sex attraction.
As part of a proposal to incorporate Lady Cass's recommendations, the health service will move away from the 'medical model' operated by the controversial Tavistock's Gender Identity Development Service in favour of a 'holistic' approach.
The new guidance will be released for public consultation imminently before being rolled out later this year.
It will be used by established children's gender clinics in London and Manchester, and was reviewed by Lady Cass at the start of 2025.
Medics will also evaluate each child's mental health, relationship with their family and sexual development, including whether they are experiencing same-sex attraction.
However, some groups criticised a 'serious flaw' in the policy as it leaves an open door to the use of cross-sex hormones. They also condemned its absence of recognition of the wider societal issues to which children are exposed.
Policy probes eight key areas
The new NHS Children and Young People's Gender Service will explore eight key areas of a child's life.
To assess 'development', doctors will take a 'detailed history' of the child's social, cognitive and physical growth, particularly because of the 'substantial' changes that take place during puberty.
They will screen children for autism and learning disabilities and look into whether further 'cognitive assessments' are necessary.
The specification says: 'Given the high prevalence of neurodiversity identified within this population, all those attending the NHS Children and Young People's Gender Service should receive screening for neurodevelopmental conditions.'
The 'multidisciplinary team' of experts, including a consultant specialising in neurodevelopmental disorders, will create a treatment plan for each individual depending on their diagnosis.
If screening 'identifies the presence of neurodevelopmental conditions, including autism spectrum disorder (ASD), a referral should be considered to the Paediatric Neurodevelopmental Service or Paediatric ASD Service,' the guidance states.
In such cases, the team of doctors will have to determine if the child's symptoms are caused by autism or whether they also need separate treatment for gender dysphoria.
They could also be kept under review every six months while getting help for their autism or discharged from the service.
Cases of both conditions have risen sharply in recent years. Recorded rates of gender confusion in under 18s have risen from 0.14 per 10,000 people in 2011 to 4.4 per 10,000 in 2021, driven largely by girls entering adolescence.
At the same time, autism has gone from being diagnosed in about one in 2,500 children, to one in 34 children aged 10-14 as of estimates for 2018.
Prof Michael Craig, clinical lead for the NHS National Autism Unit from 2007 until 2023, previously estimated half of patients seen by the Tavistock's clinic had autism after observing sessions.
In her review, Baroness Cass linked the rise in teenage girls 'struggling with gender identity, suicidal ideation and self-harm' with cases of 'undiagnosed autism, which is often missed in adolescent girls'.
She said it was the 'common denominator' with one study finding transgender people were three to six times more likely to be autistic than those who are not.
Patients at the new service will also undergo a thorough mental health assessment because of the 'higher rates of mental health difficulties' among gender-questioning children.
The NHS guidance described a previous 'reluctance to explore or address' mental health conditions because gender dysphoria was not classified as one, but said that 'identifying and treating' any mental illness should be an 'integrated part' of their care.
It added that they should undergo a 'mental state examination' and be questioned about 'mood, anxiety, emotional regulation, beliefs around weight, potential somatic symptoms, concentration, sleep and appetite, self-harm, and suicidal thoughts and behaviours'.
'Family context'
Another key area is dubbed 'family context', with medics being tasked to paint a picture of each child's upbringing and familial relationships.
The specification noted that 'there is evidence of an increased frequency of family parental physical and/or mental ill health and other family stressors in this group'.
Under the section titled sexual development, knowledge and sexual orientation, it said 'clinicians should seek to understand the child/young person's emerging sexuality and sexual orientation'.
If this has been a previous issue, doctors should consider whether the child was exposed to 'adversity and trauma'.
They will also examine the children's physical health needs and the impact of any long-term conditions, along with their broader well-being, school relationships and educational attainment.
Medical teams will 'undertake an in-depth assessment' of how the gender dysphoria 'manifested', how it has been managed by the family, if any 'social transition' has taken place and the impact of any distress caused.
They have been told to look out for 'safeguarding issues' such as 'transphobic bullying', 'online grooming' and a 'breakdown in relationships with families'.
The Clinical Advisory Network on Sex and Gender welcomed the 'proposed holistic approach and prioritisation of psychological interventions'.
NHS wait times 'very long'
Dr Louise Irvine, a GP and the group's co-chairman, said: 'The new service recognises that many also experience mental health, neurodevelopmental and/or personal, family or social complexities in their lives.
'The challenge will be to ensure NHS services can provide prompt access to appropriate service for any identified needs as waiting lists are currently very long.'
But she went on to say a 'serious flaw' in the policy was that it 'leaves the door open for referral of children and young people under 18 for cross-sex hormones'.
She described the guidance's reference to a drug policy that is 'seriously out of date, was published before the Cass Review and does not take on board the scientific reviews which showed lack of evidence of benefit of hormones in this group' as 'irresponsible'.
A spokesman for Bayswater Support Group, which advocates for evidence-based care on behalf of 600 families with trans-identifying children, said: 'The more careful and holistic assessment by the NHS is welcome, however, there is still scant recognition of the environmental factors influencing children's understanding of gender issues.
'Schools continue to teach gender identity as fact and socially transition children without parental consent. Young social media influencers monetise content claiming the health benefits of controversial medical treatments.
'And authority figures, including politicians, cast doubt on the findings of the Cass Review and falsely associate evidence-based findings with far-Right narratives.'
They added: 'Within this context, it is very difficult indeed for professionals to make accurate diagnoses or to determine the most effective support for a patient experiencing distress.'
An NHS spokesman said: 'We will soon be going to full public consultation on this draft specification which sets out the new holistic assessment framework that was described by Dr Cass in her report.
'NHS England has recently changed the referral pathway so child patients can only access gender services that we commission if they're referred by a paediatrician or a child and adolescent mental health worker.'
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Independent
2 hours ago
- The Independent
Government can hit NHS waiting times targets despite scepticism, says Reeves
The Chancellor has insisted the Government can hit its NHS waiting times targets despite scepticism from some leaders. Speaking after her spending review, Rachel Reeves said the Government was confident it could hit pledges set down by the Prime Minister last year. Sir Keir Starmer said in December the NHS will carry out 92% of routine operations within 18 weeks by March 2029. However, in March this year, the NHS waiting list for hospital treatment in England rose for the first time in seven months. The Times has also reported that internal Department of Health modelling shows the NHS is on course to hit only about 80% by the end of the parliament, with officials suggesting anything above that is overly optimistic. Asked about the pledge on Wednesday afternoon, Ms Reeves told reporters: 'We've already delivered around three-and-a-half million additional appointments since we came to office last July. 'Waiting lists are already down by 200,000 so we are confident that we can meet our plan for change commitments because of the 3% annual increase in funding for the National Health Service. 'On top of that of course, we're investing in capital spending in the NHS, including in more scanners, but also investment in the NHS digital app to make it easier for patients to access information, to book services, to take some of the costs out of the bureaucracy, as well in running our health service.' Earlier, the 3% increase in real terms for the health service per year in the spending review was welcomed by health leaders but there were warnings it is not enough. Matthew Taylor, chief executive of the NHS Confederation, which represents all health organisations, said the NHS funding boost was welcome, 'given the precarious state of public finances and will help the NHS to cope with rising demand from an aging population, often with multiple or more complex physical and mental health conditions'. But he warned 'difficult decisions will still need to be made as this additional £29 billion won't be enough to cover the increasing cost of new treatments, with staff pay likely to account for a large proportion of it'. He added: 'So, on its own, this won't guarantee that waiting time targets are met.' Mr Taylor said NHS leaders will need continued backing from the Government to redesign services and balance budgets. 'That means getting political backing when some services are redesigned or cut, including moving hospital services into the community and closer to people's homes as part of the Government's three shifts,' he said. He added that the 'flat settlement' from the Chancellor 'continues to leave a major shortfall in capital funding, and it also fails to lift the ban on private investment that is required to boost NHS capital funding'. There is currently an almost £14 billion maintenance backlog bill to repair NHS hospitals and buildings. Mr Taylor said those issues needed to be addressed in the upcoming national infrastructure strategy and 10-year plan for the health service. Government documents accompanying the spending review show that, on average, from 2023-24 to 2028-29, the NHS in England will receive 3% real terms growth in day-to-day spending, equivalent to a £29 billion real terms increase in annual budgets. The Department of Health and Social Care (DHSC) budget will increase by £2.3 billion in real terms by 2029-30, compared with 2023-24, 'representing a more than 20% real terms increase by the end of the spending review period', the documents said. Overall, the figures suggest DHSC spending will rise 2.8%, though this is less than the average 3.6% in recent years. Sarah Woolnough, chief executive of the King's Fund charity, said the 2.8% average increase in DHSC spending – or 3% for day-to-day NHS spending – 'will have been hard-fought for in the spending round negotiations, despite still being lower than the historical average the NHS has received over recent years'. She added: 'We know there are already trade-offs happening in the NHS due to tight finances. 'The Chancellor said she wants the public to have an NHS there when they need it. 'It is hard to see how all the things she mentions: faster ambulance times; more GP appointments; and adequate mental health services and more; can be met on this settlement alone. 'Particularly when large parts of this additional funding will be absorbed by existing rising costs, such as the higher cost of medicines, which are currently being negotiated, and covering staff pay deals.' According to spending review documents, the Government expects the NHS to deliver 2% productivity growth each year, 'unlocking £17 billion savings over three years' to reinvest back into the NHS to improve patient care. The Government will also invest up to £10 billion in NHS technology and digital transformation by 2028‑29, the documents showed. NHS England boss Sir Jim Mackey, speaking at the NHS ConfedExpo conference in Manchester, said the NHS has done 'really well relative to other parts of the public service'. He added: 'But we all know it's never enough because of the scale of advancement, all the ambition, all things we want to do, the day-to-day cost pressures we're trying to get on top of, etc. 'We're always going to be in a world where we want more money, but I think everyone's starting to accept and understand that we've got what the country can afford to give us. 'We really need to get better value for that money – it is broadly the equivalent of the GDP of Portugal, so it's a huge amount of money by any standards.' NHS England has already budgeted a 2.8% increase in pay for staff in 2025-26, but many leaders the King's Fund spoke to were worried about funding pay rises above this amount. After the spending review, Royal College of Nursing (RCN) general secretary, Professor Nicola Ranger, said staff will now decide whether the 3.6% pay rise offered by the Government is enough. She added: 'Against a backdrop of other cuts, nursing staff will see the NHS being protected but not transformed by today's spending plans. 'When the Government lays out its vision for the future of the NHS and its workforce, it must say how it intends to reverse collapsing student recruitment, boost retention and deliver urgent, structural reform to nursing pay.' Nuffield Trust senior policy analyst, Sally Gainsbury, said: 'Compared to the settlements for other departments – from policing to education – the NHS deal looks generous. 'But seen in the context of all the promises made by the Government to the British people – to drive down waiting lists, shift care closer to home, rapidly improve tech – and the commitments to meet staff pay demands and rising costs of new drugs, today's settlement soon melts away. 'With capital funding staying flat in real terms for the rest of the spending review period, it will be difficult for the NHS to invest in the technology and facility upgrades it needs to meet the Government's ambitious productivity targets.'
North Wales Chronicle
2 hours ago
- North Wales Chronicle
NHS should ‘tear up the outpatient model'
Around 130,000,000 outpatient appointments – procedures or appointments which take place in hospitals or clinics but do not require an overnight stay – take place in the NHS in England every year. The majority of people on the NHS waiting list are waiting for outpatient appointments. An estimated 7.42 million treatments were waiting to be carried out at the end of March, relating to 6.25 million patients, according to official figures. The latest performance figures for the NHS in England are due to be published on Thursday. Sir Jim Mackey, chief executive of NHS England, told the NHS ConfedExpo conference that the service should take 'big leaps' such as 'tearing up the outpatient model' and 'tearing up the frustrations about technology' and 'tearing up the multiple touch points for patients when it should be one'. And Dr Penny Dash, chairwoman of NHS England, told delegates: 'There are seven and a half million people on the waiting list, half of them waiting more than 18 weeks, and the majority of those people waiting for an outpatient appointment. 'Surely we can fix outpatients to help bring down the waiting list.' Matthew Taylor, chief executive of the NHS Confederation, said: 'Outpatient services should and could be transformed with most checks and follow-ups done in neighbourhoods or remotely.' Meanwhile, Sir Jim said the NHS has 'lost its way' on quality of care, as he told delegates that the forthcoming 10-year plan for health, which is to be published in July, will 'focus on quality'. 'Neighbourhood care – I think that part of the plan is still a really big standout for me,' he said. 'The focus on quality, I think it's really welcome – we have lost our way a little bit on quality coming out of Covid, and again, looking at quality in the round and not just safety.' But he said that the NHS would move on from the 'over-prescription centrally' and the 'labyrinthine approval processes' to give local health leaders more freedom. Dr Dash added: 'We do need to have a comprehensive strategy for quality. 'We've had a big focus on safety, rightly, over the last 10 years, but that has been a bit at the expense of patient experience and also effectiveness. We need to regroup, set out that strategy.'
South Wales Guardian
2 hours ago
- South Wales Guardian
NHS should ‘tear up the outpatient model'
Around 130,000,000 outpatient appointments – procedures or appointments which take place in hospitals or clinics but do not require an overnight stay – take place in the NHS in England every year. The majority of people on the NHS waiting list are waiting for outpatient appointments. An estimated 7.42 million treatments were waiting to be carried out at the end of March, relating to 6.25 million patients, according to official figures. The latest performance figures for the NHS in England are due to be published on Thursday. Sir Jim Mackey, chief executive of NHS England, told the NHS ConfedExpo conference that the service should take 'big leaps' such as 'tearing up the outpatient model' and 'tearing up the frustrations about technology' and 'tearing up the multiple touch points for patients when it should be one'. And Dr Penny Dash, chairwoman of NHS England, told delegates: 'There are seven and a half million people on the waiting list, half of them waiting more than 18 weeks, and the majority of those people waiting for an outpatient appointment. 'Surely we can fix outpatients to help bring down the waiting list.' Matthew Taylor, chief executive of the NHS Confederation, said: 'Outpatient services should and could be transformed with most checks and follow-ups done in neighbourhoods or remotely.' Meanwhile, Sir Jim said the NHS has 'lost its way' on quality of care, as he told delegates that the forthcoming 10-year plan for health, which is to be published in July, will 'focus on quality'. 'Neighbourhood care – I think that part of the plan is still a really big standout for me,' he said. 'The focus on quality, I think it's really welcome – we have lost our way a little bit on quality coming out of Covid, and again, looking at quality in the round and not just safety.' But he said that the NHS would move on from the 'over-prescription centrally' and the 'labyrinthine approval processes' to give local health leaders more freedom. Dr Dash added: 'We do need to have a comprehensive strategy for quality. 'We've had a big focus on safety, rightly, over the last 10 years, but that has been a bit at the expense of patient experience and also effectiveness. We need to regroup, set out that strategy.'
