The NHS child gender clinic

BBC Radio 4 - Best of Today, The NHS child gender clinic

‘Doctors at the UK’s only NHS children's gender clinic are misleading patients and making decisions about treatment that will have an impact on their lives, their whole lives. It would be a serious allegation whoever made it but it comes from a former member of staff, Dr. Kirsty Entwistle, who is a clinical psychologist has written an open letter in which she says accusations of transphobia are preventing the clinic staff from speaking out. Well Paul Jenkins is the chief executive of the Tavistock and Portman NHS Foundation Trust. And he’s here in the studio… one of the things she says is that clinicians tell children and families that puberty blockers, these hormone blockers are fully reversible. But the reality is that no one knows what the long term impact is, on children's brains. Is that true that the reality, the long term reality is not known?’

‘So can I start by saying I'm absolutely clear that the service we offer through the service is safe, caring and thoughtful in its approach to a very contestable contested and complicated issue. To turn to the issue of the medication, there are a number of interventions that are offered. And actually it's worth noting that only less than 50% of people who are referred to our service actually end up being referred to a hormone treatment. But the first one that the hormone blockers are referred to is reversible, it's actually used in a much broader range of indications than just gender dysphoria. And it's been used for around 30 years.’...

‘She says we don't know. Because we don't know the long term effect of these on the brain’

‘So what I would say is this is, so it's a very contested area of medicine’

‘Hang on a second, if it's contested why are you not telling people that it’s contested, rather than saying that it's fully reversible?’

‘The puberty blockers are reversible. What I would say more generally, is this is an area where we need to be thoughtful about our practice, we need to hear concerns like the one that’re raised here and give proper attention to them. But what as a service we've really been committed to is participating in long term research. So our trust was awarded a significant grant to do the first long term outcome study.’

‘But hang on, on the one hand, you're saying that they do not have a long term effect. On the other hand, you're saying we need to do research to find out if they do have a long term effect’

‘I’m talking more broadly about the impact… of all the interventions’...

‘She says as well, there are children who have had very traumatic early experiences and early losses who have been put on the medical pathway without having explored or addressed their early adverse experiences. If you make the mistake of suggesting this in a team meeting, you run the risk of being called transphobic’

‘I would be very disappointed if that was a view of our service, we take a very thoughtful approach, we don't, we're not wedded to a medical model. And the whole purpose of the GID service is to explore with each individual, what is best for that young person, take account of their circumstances. And in some cases, we will take a very long time to come to a view about what the best approach working with that’

‘But in some cases, will you say look, you have had a traumatic experience, it is probably that that has caused you to come to us. You are not someone who should be transgender.’

‘I think there are two things here, I think we need to respect the feelings and experiences of young people who are uncomfortable with their natal gender and give proper respect to that. We may also need to explore a whole range of things that have happened to young people in their, in their lives, some of which may be relevant to their feelings, some of which may not be and I would feel that our service is set up in a way that does give space to explore those more complex, more complex issues.’

‘So are you willing to to say to children and to their parents who come to you no, we think our service is not for you?’

‘Yes. And I think there are cases where we will come to that conclusion’

‘Right. So there are people. So again, she's wrong. You turn people away and say this is not for you.’

‘Yeah. Yeah.’

‘She says that it is highly unlikely that any child presenting at the clinic will be told that they're not transgender. Again, that's false, isn't?’

‘I'm not, I think it's unhelpful to see these as black and white issues, as I said, the purpose of the service is to explore on an individual basis with those young people and their families, what they're feeling, what their experiences are, not to dispute the genuineness of how they feel about their-’

‘But that's the problem, isn't it? What she is saying is that you feel nervous, and people will fully understand why you feel that you want to be inclusive, and you want to talk to them about things that they genuinely feel. But what she feels, it seems from this letter, is that you've got the balance wrong, and you are not able because you're frightened of being labeled as transphobic, including members of staff inside the organization. There is this failure to be blunt with people on occasions and say, look, this isn't for you.’

‘So again, I think that's not the way that, I can well understand some of the pressures that are individual members of staff, we've heard some of those concerns. We are trying to look at some of our processes and procedures to make it easier for clinicians to concentrate on that individual, work with young people rather than being swayed or influenced by some of the very heated debate about the issue that exists in the outside.’

‘And when the heated debate takes place, this is another, the last thing she calls for. She says you must protect and support staff when they're falsely accused of transphobia and take formal action against people who make false accusations. Will you?’

‘Well if those issues were raised with me, and I think one of the disappointments here is that those issues were not raised in the organization, then, yes, we would if that was justified.’