Child gender clinic reform 'under threat', says Sajid Javid

A former health secretary has warned reform of England and Wales' youth gender service is "under threat" over concerns that staff involved in past failings will still have key roles.

BBC Newsnight has learned a clinician from the existing gender clinic, due to be closed this year, has been given a training job in the new service.

Sajid Javid said appointment processes should be "urgently reviewed".

NHS England said the new services would offer a new clinical approach.

The Gender Identity and Development Service (Gids) is the only designated NHS gender clinic for children and young people in England and Wales. It provides an assessment service and can refer them for medical treatments such as puberty blockers - or hormones when they are old enough.

Based at London's Tavistock Centre, it was earmarked for closure last July after an interim report raised concerns about the clinic's reliance on "predominantly an affirmative, non-exploratory approach" to young people who identify as trans.

The report by Dr Hilary Cass, part of her independent review of children's gender identity services, detailed the concerns of some medics who believe this approach allowed other issues such as autism and mental health problems to be overlooked in some cases.

NHS England announced plans to replace Gids, which had been rated "inadequate" by the healthcare regulator, with two new regional hubs - one in London, the other in north-west England.

Following criticism of the old service, the BBC has now learned of concerns about two members of staff appointed to train new staff at the regional hubs.

One is a senior clinician at Gids who says they are "devoted" to an affirmative approach to young people presenting with gender difficulties, and that "social justice" underpins all their work.

Another person appointed, who is not employed by Gids or the trust that runs it, has openly questioned Dr Hilary Cass and NHS England's more cautious stance on social transition - the changing of a young person's name, pronouns, and way they dress. Dr Cass and NHS England argued that it is not a neutral act, and that it can have a psychological impact on children.

Meanwhile, some applicants invited for interview for roles at the new services were initially informed that Polly Carmichael, who has been in charge of Gids since 2009, would be on the interviewing panel - a decision the BBC understands was later reversed.

Dr Carmichael communicated to Gids staff not to seek external safeguarding advice, an employment tribunal concluded in 2021. During her tenure, the leadership of Gids was also rated as inadequate by healthcare regulator the Care Quality Commission.

Mr Javid, who was health secretary when the decision to close Gids was made following last year's report by Dr Cass, told Newsnight that staff who had been involved in failings at the clinic should not be involved in training people appointed to its replacement.

In a statement he said: "Individuals who oversaw significant failings at the Tavistock should clearly not be managing the set-up of the new system."

He said the approach at Gids was "overly affirmative" and "bordered on the ideological".

Gids has maintained that being respectful of young people's gender identities did not prevent the service from exploring other issues that may affect them.

Current Health Secretary Steve Barclay told the BBC the government would ensure the new service was run in line with the recommendations of the independent Cass review, which "differ significantly" from the services provided by Gids.

He said: "Any suggestion that the recruitment or training of new service providers are not following these recommendations is very concerning and I will work closely with partners to resolve this."

Great Ormond Street Hospital for Children NHS Foundation Trust, one of the trusts due to run the new service in London, was in charge of the recent recruitment process.

A spokesperson for the trust said it wanted to recruit a wide range of staff to collectively develop training materials in line with the Cass review recommendations.

"While we appreciate they may hold differing views, there will be strong governance processes in place" to ensure the training aligns with the review's recommendations and the latest evidence, the spokesperson said.

Dr Cass and international experts have been invited to join an oversight group to sign off on the curriculum, Great Ormond Street said.

The BBC understands that the trust will be interviewing further external candidates for the education role and that pre-employment checks are under way for candidates who have been offered roles so far.

A sharp rise in the number of young people presenting with gender issues has led to lengthy waiting times for treatment - a time of great uncertainty and stress for the young people and their families.

One couple, David and Diana, whose names have been changed to protect the privacy of their child, told the BBC their child had already been on the Gids waiting list for 18 months.

Speaking about the new services, David said he felt Gids "shouldn't be anywhere near it".

His partner, Diana, said: "There needs to be proper evidence-based care and real accountability and recordkeeping and aftercare - all of that stuff that's been so sorely lacking."

Children questioning their gender and their families have widely varying views about how care should be provided, with some wanting a cautious approach while others believe there should be faster access to medical interventions.

Gendered Intelligence, a trans-led charity, said it was not for them to question NHS England's approach to staffing, but it wanted more support and better communication for those already receiving treatment or on the waiting list.

"What we want to do is advocate for these young people being looked after better," spokesperson Cleo Madeleine said.

NHS England said: "All aspects of the new children and young people's gender service - from the development of both the interim and final service specification, including staff training, to individual patient care - will be guided by the ongoing findings and expert advice from the Cass Review."