Tavistock: Top doctor questions need for change at gender clinic

A doctor with a key role in reforming a controversial gender identity clinic for children has been recorded questioning the need for change.

Prof Gary Butler, clinical lead for the children's gender clinic in England and Wales, also appeared to accuse the author of a report, which will underpin the new service, of "nepotism".

He was recorded making the comments in a keynote speech at a major conference.

When asked about the speech, he said he fully supported plans for new services.

The Gender Identity Development Service (Gids), based at London's Tavistock and Portman NHS Foundation Trust, was rated as "inadequate" by inspectors, who visited in late 2020. It was earmarked for closure in July 2022.

An independent review, led by Dr Hilary Cass, also called for a "fundamentally different" model of care for children with gender dysphoria.

Prof Butler has been awarded a key role in shaping the new service, as one of several people tasked with implementing a new training programme, underpinned by Dr Cass's recommendations.

However, BBC Newsnight has learned Prof Butler - the current service's most senior doctor - has publicly questioned the need for change and described Dr Cass's recommendations as "slightly unusual".

In the 14-minute speech at the conference, he talked about current services across the UK, the legal challenges to the situation in England, and how he felt Gids has been the subject of "lies" in the media.

The consultant paediatric endocrinologist at University College London Hospitals (UCLH) told the conference of hundreds of transgender healthcare professionals how the Cass Review had highlighted the need to provide "developmentally appropriate healthcare for children and young people".

"But what on earth are we doing now?" he told the European Professional Association for Transgender Health conference, which was held in Ireland, last month. "It's exactly what we're doing at the present time, and what the Gids is doing."

Speaking about the new proposals, he said instead of expanding gender care, "they've almost contracted it".

In the recording, which was then handed to Newsnight, he was also heard questioning the personal integrity of Dr Cass. He implied there had been, what he referred to as, nepotism around the choice of two hospitals in the south of England as the sites for new clinics - suggesting Dr Cass's previous involvement in them both had been a factor.

NHS England says the two new regional hubs, which will replace Gids, are taking longer than anticipated to set up. They are intended to offer a clean break from the past.

But referring to the hospitals, which will form these new hubs, Prof Butler appeared to question the need for a more diverse workforce, telling the conference that none of the staff had "any experience of management of gender incongruence in young people". He added: "It's shocking."

In his role at UCLH, Prof Butler is responsible for prescribing medication including puberty blockers and hormones to young people who have been assessed by Gids as suitable for such treatments.

Gids will now remain open until at least March 2024. Meanwhile, there are more than 8,000 young people currently waiting for care.

In a statement, Prof Butler said Newsnight's reporting of his comments were "highly selective" and that his views were made as part of a wider presentation on gender identity services in the UK. "I wish to make clear that I fully support Dr Hilary Cass's recommendations to develop new services for young people experiencing gender dysphoria," he added.

The Cass Review team said, while it accepts that people hold different views on how services should develop, there was "general consensus that the current model, within a single specialist gender service, cannot provide timely, holistic care for the mix of children and young people seeking support".

It said Dr Cass did not select which hospitals would form the new regional centres, saying accusations to the contrary were "baseless".

While Gids has helped some young people, critics - including young trans people seen by the clinic - claim it was sometimes too quick to refer young people for medical interventions and it could overlook mental health difficulties.

"They push the drugs on you so early on," Em, a 19-year-old trans man, who has identified as male since early childhood, told Newsnight. Em says he was offered medication during his second appointment, adding: "I was 11."

After five appointments, Gids referred Em to UCLH for puberty blockers. These were prescribed by Prof Butler when Em was 12. He stayed on them for nearly four years.

While the blockers slowed Em's puberty, they didn't stop it. He was put on higher doses and, when that did not work, he was administered beta blockers. Em later collapsed at school.

"To me that was dangerous", Em's mother told Newsnight. Em suffered violent mood swings and gained lots of weight while on the blockers.

He stopped taking puberty blockers in 2019 and hasn't chosen to take hormones to masculinise his body. Since being discharged in 2020, neither Gids nor UCLH has been in touch with Em.

"I feel completely forgotten about," he says now. "I still don't know what is happening with my body [or] what the blockers did."

The NHS says little is known about the long-term side effects of puberty blockers in children with gender dysphoria. Dr Cass has insisted there needs to be more research.

Both the NHS and Dr Cass have made it clear that staff at the new gender identity services for children must have wider experience of working with young people - including expertise in autism, mental health and safeguarding.

Em says the new services must be different. "The new system needs to be a mental health service," he says, and offer more holistic care for trans people. "For them, you weren't transgender unless you're willing to go the full way [in medically transitioning]. I was a child. I did not know what I was doing."

In a statement, the Tavistock and Portman NHS Foundation Trust said it had reviewed Newsnight's claims, adding that they "do not align with the evidence we have", though it declined to give specifics about that evidence.

It said it works on a case-by-case basis with every young person, their family and local services, but said it was inappropriate to comment on Em's individual patient care.

"Patients who begin medical treatment do so only after they've been fully assessed (including mental health), and only if the parent/carer is supportive," the trust added.

A UCLH spokesman also said it would be inappropriate to comment on an individual patient's care, but added that Gids clinicians "discuss non-medical interventions with patients before and after referral to our endocrinology clinic".

"Patients only begin medical treatment if they are assessed as having full competence to consent and there is parental support," UCLH said, adding that the clinic follows the service specification set out by NHS England.

NHS England, which commissions children's gender identity services, said all aspects of the new service would be guided by the ongoing findings and expert advice from the Cass Review.

A spokesperson for the Department of Health and Social Care agreed, adding that an oversight group will ensure training is in line with the new clinical approach.