A POTENTIAL medical negligence scandal looming in England has implications for Scotland and needs urgent attention. London’s Tavistock gender clinic is facing the threat of legal action from 1000 children and their families who claim they were misdiagnosed and placed on a damaging and irreversible medical pathway without proper informed consent or consideration of alternative therapies.

The children concerned were being treated for gender dysphoria, a condition which is best understood as a sense of unease because of a perceived mismatch between their biological sex and what has come to be known as their “gender identity”.

In recent years, there has been a rapid increase in the number of children presenting with this condition, particularly girls. At the same time, the services provided have moved from a psychosocial and psychotherapeutic model to one that also prescribes medical and surgical interventions such as puberty blockers, cross-sex hormones and double mastectomies.

In autumn 2020, NHS England and NHS Improvement set up an Independent Review of Gender Identity Services for Children and Young People to make recommendations about the services provided by the NHS in England. Dr Hilary Cass, an eminent paediatrician, was asked to chair it.

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In March of this year, she submitted an interim report which concluded that the Tavistock clinic had failed vulnerable children and should be shut down by spring of next year at the latest. It will be replaced by regional centres at children’s hospitals, which are to offer a more holistic model of care with strong links to mental health services. Cass found that the current model of a centralised national service for children and young people who experience gender dysphoria puts them at significant risk.

Many children have been put on a medical/surgical pathway with insufficient exploration and often little consideration of consent. There has been a lack of follow up of those who have undergone this type of experimental treatment, so Cass also calls for the rapid establishment of a formal research programme in England and Wales involving children and young people being considered for hormone treatment into adulthood, with a particular early focus on the use of puberty blockers.

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Cass recommends that children expressing distress about their sex should be treated like any others with psychological problems and offered compassionate and appropriate services which properly address all their needs.

Children who experience a sense of unease because of a perceived mismatch between their biological sex and what has come to be known as their “gender identity” often have other problems, including past trauma and sexual abuse, autistic spectrum disorder, and wider mental health difficulties. Many of these children are lesbian, gay or bisexual and simply need help to be comfortable with their sexual identity as they grow up.

One of the most disturbing aspects of what has happened in England has been the efforts to silence whistleblowers and brand them as “transphobic”.

One psychotherapist and child safeguarding expert at the Tavistock, Sonia Appleby, won damages from an employment tribunal after she was vilified and prevented from carrying out her safeguarding role after raising concerns. Her colleague, David Bell, a consultant psychiatrist commented that the service had become “so caught up in the politicisation of the subject of gender identity that it had lost sight of its duty to safeguard children”.

Some staff have left the service over their concerns. They have spoken of their fears that the cause of many children’s distress was unchallenged homophobia and have given examples of children who presented as trans after months of bullying for being gay or because of homophobia at home.

They reported that many families talked about not wanting their daughters to be lesbian and that young people frequently confided their disgust at being gay. These clinicians said that they felt what they were doing was conversion therapy for gay children.

Concerns over the treatment given to children suffering from gender dysphoria are not confined to the UK. This week, the Sydney Morning Herald reported on the case of a young woman in Australia who has brought a claim for medical negligence against a psychiatrist who advised her to have breasts and womb removed after only three consultations when she was just 19.

She was suffering from gender confusion against the background of a complicated home life and worry about her attraction to other girls. Her treatment and living as a man caused her further distress and she has gone back to living as a woman.

Her solicitor says she expects extensive litigation in Australia in the coming years from others who have received hormonal and surgical treatment without adequate counselling. The initial referral in this old woman’s case described her as “very young” and “clearly”needing “thorough psychiatric work-up before embarking on hormone treatment”.

Many of the children treated at the Tavistock are a lot younger than 19. So, what are the implications for Scotland? We have our own national gender identity service at the Sandyford clinic in Glasgow. It has been operating on the same model as the Tavistock and, as you might expect, there are strong indications that patients and service users are experiencing similar problems to those identified by Hilary Cass.

The Scottish Government has said it will carefully consider the final recommendations of the Cass review for the Sandyford clinic. However, the implications of the interim findings are so serious, action is needed sooner. Whether there the is time or the need for replicating the Cass review in Scotland is questionable. There is certainly plenty of room for read across.

Until earlier this week ,the position of NHS Healthcare Improvement Scotland (HIS), which is tasked with improving Scottish healthcare, was that it had never been asked to inspect, review or carry out improvement work with the Sandyford young gender clinic. But now HIS has confirmed that the Scottish Government has ordered it to work on guidelines for the care of children experiencing gender dysphoria.

It is more than a little concerning that such guidelines do not already exist. Apparently the newly commissioned ones will not be ready until December of next year. That is too far away. In the light of the Cass review and the looming litigation scandal this issue needs far more urgent attention.

That is why I joined forces earlier this month with the former leader of the Scottish Green Party, Robin Harper OBE, to write to the national clinical director, Jason Leitch, demanding swift action.

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The Scottish health system rightly prides itself on its innovative work on patient safety and data driven health care improvement. Patient safety and person-centred care mean ensuring that children and young people in Scotland receive a high standard of care and that the services provided to them are safe, effective and centred around the individual.

Experience should inform practice going forward so that lessons can be learned, and mistakes not repeated.

Press reports suggest that the Sandyford is already contacting patients who have transitioned as a result of their advice and then regretted it. They should also speak with feminist and LGB groups which have been advocating for the more holistic approach recommended by Hilary Cass.

It was concerns like those expressed by Cass that led me to argue that it was imperative that a ban on conversion therapy did not extend to a ban on proper talking therapies for children who are distressed about their sex or gender identity. I hope that those who attacked me for doing so will think again in the light of the evidence heard by Cass and her recommendations.

For too long, those who have expressed concern about the medicalisation of children distressed about their sex have been silenced by unfounded allegations of “transphobia”. Now that concerns for the welfare of such children have been legitimised by the findings of an independent expert review, it is time for the Scottish Government and NHS Scotland to act quickly.

The potential cost to the NHS if they fail to do so should concern us all but it is the irreversible impacts on the lives of the children concerned that is the real scandal.