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NHS England to tell some transgender children to medically detransition or face safeguarding referrals
Explainer Transgender

NHS England to tell some transgender children to medically detransition or face safeguarding referrals

Jamie Wareham
Jamie Wareham
TL;DR: QueerAF has confirmed that leaked guidance seen by the Good Law Project is in use by NHS England. It reveals the 6000+ children currently on the waiting list for the new Children And Young People’s Gender Service are being invited to have their mental health assessed. At these assessments children and their families will be advised to stop gender-affirming treatments, and that if they continue without “appropriate care” they could face safeguarding referrals. It could result in young people being forced to medically detransition.

NHS England is going to give some 6000+ transgender children advice that may leave them no choice but to medically detransition or face safeguarding referrals according to leaked plans, which NHS England has confirmed to QueerAF are in use.

The documents leaked by the Good Law Project say that if young people and families using “unregulated” and “overseas providers” for gender-affirming care they should stop, and if they continue without “appropriate care” they may face safeguarding referrals.

“It's reasonable to describe this as an attempt to force people to detransition,” Jo Maugham KC, Executive Director of the Good Law Project tells QueerAF.

In response to our story, an NHS England spokesperson told QueerAF this process is about putting in place an "enhanced mental health support offer for all children and young people under 18 on the waiting list for specialist gender services, or who are awaiting their first appointment with the new services."

They add that it is optional and that: "Patients will be given the choice whether they wish to take up this support offer, and whatever the outcome of their appointment with a mental health professional, their place on the waiting list for the gender service will not be affected."

What do the documents say?

The documents ask providers of mental health support for children and young people to invite those on the national waiting list for gender services for a face-to-face appointment. The non-profit campaign organisation says that some providers of this care have been asked to do this by 30th June 2024, less than eight weeks from now.

The process will require healthcare providers to send a "Gender Experience Summary Form" which will seek to gather information about whether the young people or their families are receiving support from "the private sector or from abroad [such as] hormone treatment."

The document goes further, naming one service, Gender GP, that has been the centre of a media frenzy this week amid news a doctor who advocates for "partial pubertal suppression" said it had prescribed "dangerous" levels of testosterone.

It says the service is the largest “provider” of private gender-affirming prescription cases, and that it is registered overseas and therefore “outside the reach of the UK health regulators.”

At the assessment the providers have been asked to “advise” children, as per the recommendations of the Cass Review, not to take puberty blockers or gender-affirming hormones obtained through these routes without "appropriate care." However, the leaked document does not identify what "appropriate care" means but does advise against "unregulated" and "overseas" providers of care, which rules out the vast majority of private gender-affirming healthcare.

If a young trans person is then found to disregard this advice in a way that the provider considers "puts the child/young person at increased risk" then they are told to consider a safeguarding referral "in line with standard safeguarding approaches."

The implication of this process is if a trans young person decides to pursue private gender-affirming care and their parents support them, they could be referred to local authorities.

Are parents and young people being deceived?

Many young trans people who are waiting for an appointment and are seeking or are on gender-affirming hormones or puberty blockers may be left with no option but to medically detransition or face child protection procedures and assessments.

This is, however, explained to parents and young people being invited for these assessments, one which is designed to give them "enhanced support". Good Law Project says a sample email sent to a parent of a young trans person says:

“We understand it cannot be easy for [name] having to wait a long time to be seen by specialist Gender Services. Therefore, the NHS wanted to offer them some support through local Children and Young People Mental Health Services [CAMHS].”

It's wording that Jo Maugham says is designed to deliberately mislead young trans people and their families. “What's most troubling is the difference between what this exercise is really about and what it pretends to be to parents. It is duplicitous,” he tells QueerAF.

This news comes hot off the back of the Cass Review, a long-awaited review into child gender identity services by NHS England. It recommended a pause on prescribing transgender young people puberty blockers, which has now been implemented in England and Scotland until an as yet unannounced trial has been completed - QueerAF

It also recommends a new service for 17-25 year old transgender people is set up, which will have a focus on considering alternative reasons for their gender-related distress, such as eating disorders, neurodivergence, or social acceptance.

It’s an approach journalist Sasha Baker argues "offers all the harm of conversion therapy, with the convenient excuse that transition may be considered if all other avenues have been exhausted" - Dazed

The plans seen by the Good Law Project corroborate this analysis. A roadmap designed to leave people with no choice but to detransition, and consider ‘alternative reasons’ for their gender dysphoria.

If the documents are implemented in this form, it could see the government face accusations of a form of state-mandated conversion therapy. Meanwhile, LGBTQIA+ sector groups have expressed their “significant concerns”. 

“These proposals are a far cry from the mental health support that many trans young people need whilst they endure lengthy waits for gender-affirming care”, Pip Gardner, CEO of The Kite Trust told Diva

“We have significant concerns that elements of this approach will further exacerbate the trans community’s lack of trust in the NHS. Families have turned to private health care because the NHS has failed to provide them with timely support and the proposed approach suggests commissioners are more interested in passing the buck and demonising families in difficult circumstances rather than providing them with meaningful support.”  

Ahead of the Cass Review's release it was revealed that some of those writing the report have direct links to a group that advocates for the practice of so-called ‘conversion therapy’ - something they didn't declare. Dr Hillary Cass herself met with staffers of 'Don't Say Gay' architect Ron De Santis, who went on to ban trans healthcare in Florida - Trans Safety Network

Meanwhile, after multiple u-turns and an ongoing understanding in the sector that the government would include transgender people in a proposed ban on so-called conversion therapy, reports suggest it has now dropped those plans. Dr Cass spoke about the ‘risks' of criminalising professionals based on her report's recommendations too - Guido

The leaked guidance doesn't include any information or warnings about the risks of detransition. Gender-affirming care has been shown, in a number of studies, including some deemed low quality by the Cass Review, to lower the risk of suicidal ideation, suicide and self-harm. For want of a better phrase, this care ‘saves lives’ - Columbia University

We contacted the Department of Health and Social Care for a response. An NHS spokesperson provided a full response after publication, which was added at 4 pm 04/05/2024.

Information is everything.

It helps us reach and justify conclusions. But the information ecosystem is failing us.

When the Cass Review was released, news outlets highlighted the report's conclusions without taking time to consider whether the report could be flawed.

In doing so, it amplified and solidified to the wider public the report's key conclusions without balancing it against the evidence it excluded to reach them.

While much of the news media zoned in on that conclusion, trans activists, healthcare experts and the LGBTQIA+ sector combed through it line by line to show it was another official report captured by harmful, prejudiced rhetoric.

Crucially, despite a four-year process, it still failed to find any smoking gun of widespread regret among trans folks who transition. It instead had to rely on a methodology that allowed it to deem any data about how gender-affirming care helps trans people as too low quality. Whether your analysis means that led to it being ignored or excluded is by the by - it was downgraded.

It's not enough to know what the Cass Review says. We need to understand why it reached those conclusions.

When we do, we can see it for what it is rather than what it's been reported as.

At QueerAF, we'll always take stock - and deliver accountability journalism with our unique slow news approach, so you understand why.

We think that approach is essential so you have the information you need to fight back against anti-LGBTQIA+ rhetoric.

If you find it valuable, please consider becoming a QueerAF member and giving each month so we can deliver even more of it.