Thread by @DadTrans

UK Newspapers are repeating the lie that trans kids are being 'fast tracked' for medical care. The reality is anything but. Let me break it down for you, from someone who has a child is in the NHS monopoly service. [MEGATHREAD]: 1/

Imagine the following common scenario, you are a parent/carer, & your child comes out to you, tells you they are trans. Most of the time, they will have been thinking about this for some time, often years, you may even be the last to know. It can be difficult for parents 2/

I know, I've been there, (huffingtonpost.co.uk/entry/the-mome…), imagine then, how hard it is for the child. Unfortunately many parents are unable to accept. They ignore - pretending it never happened, deny- shutting down the child, or react with intimidation or violence 3/

The National LGBT Survey found that for 16-17 year olds only 40% had been open about their trans identity with all family members they live with. & across ages, 45% avoided being open about their gender identity at home for fear of a negative reaction gov.uk/government/pub… 4/

We also know from the LGBT Survey, that 69% of respondents had started to transition while at school. So there is a discrepancy. Many of these children & young people did not feel able or safe to tell their closest family members... However, back to our optimistic scenario. 5/

You've been told by your child they're trans (or identify as a different gender than you'd thought) you look at the NHS pages on gender dysphoria follow the advice, making an appointment with your GP. This next stage is a lottery, or as recently commented Russian Roulette 6/

You may be lucky & encounter a GP who has some knowledge of gender dysphoria. congratulations! In many cases, (& in our experience) the GP will have no knowledge of gender identity issues in children. Many will wrongly view gender identity as a mental health issue 7/

Commonly, GPs will dismiss, putting this down to "a phase", tell you they cannot do anything until the young person is 18, or refer on to child & adolescent mental health services (CAMHS) 8/

Many CAMHS refuse to see trans kids, those who do have lengthy wait lists. What the GP can & should do, is refer directly to the single provider of gender care for children - the Gender Identity Development Service (GIDS) at the Tavistock & Portman -aka the Tavistck or Tavi 9/

The current published waiting list for GIDS is 20 months, though parents are reporting 22 months. This is the minimum wait for supported trans kids (the 40% minority), who are not given the brush off by their GP, or sent on a 12 month delay via CAMHS. Twenty. Two. Months. 10/

In no other area of child health is @NHSEngland statutory 18 week waiting list promise so broken. While waiting there is no support until you finally receive an offer of an appointment. You must confirm that you intend to attend or you are kicked off the list & must restart 11/

When you arrive at GIDs the family meets the two assigned clinicians. These are a random allocation from a pool of psychologists, psychotherapists, family therapists & social workers. None of these are medical doctors. This is a complete lottery. 12/

Some clinicians are kind, caring but inflexible, bound by GIDS own deeply conservative protocols in terms of access to medical treatment. Some are actively harmful. By actively harmful I mean undermining, bullying, dismissive, mentally abusive, intentionally inflicting hurt. 13/

If you are unfortunate enough to be allocated one or more of these clinicians there is little chance of ever being put forward for medical treatments. In our (optimistic) scenario though, you've got at least one clinician who believes that trans children can & do exist 14/

They assess your child for gender dysphoria - according to the NHS Service Specification this takes between 3 and 6 months. GIDS interpretation is minimum six. This is six hour long sessions, in part with all family together & part with child & family separate 15/

Many families find these sessions helpful. Many don't. There are many forms, many probing questions. The principal objective is to determine whether the young person is able to demonstrate they experience gender dysphoria & are therefore potentially eligible for treatment 16/

For those age 12+ this assessment period takes an average of 9.6 months (growinguptransgender.com/2019/02/13/off…). For access to the first stage of medical treatment (reversible puberty blockers), the adolescent must be able & willing to convince their clinician's they have gender dysphoria 17/

They must also persuade them they have entered puberty (Tanner stage 2) & that they can consent to treatment. To be successful in these time-frames they need to have supportive parents (not just one), be allistic, binary, clear of their sexual orientation, & not 'too sad' 18/

They must have bodily dysphoria about their primary sex characteristics, and be attending school full time, and not have other life trauma, etc etc etc. If they meet this very high bar, they may be referred to the next stage - UCL Endocrinology. 19/

There is now a further delay "a wait of several months is likely" (GIDS website), & 2-3 months seems to be common. There is a first appointment where bloods are taken, then another delay of 2-3 months, while the GP is contacted for approval to undertake shared care 20/

To re-cap. The very quickest a 12 year old or over can access hormone blockers (a commonly prescribed medicine used for over 40 years in cases of precocious puberty) is 22 months + 9.6 months + 2 months, + 2 months = 35.6 months. Lets just call it three years. THREE. YEARS. 21/

This is the best case Magical Christmas land, scenario. Supportive parents + Supportive GP, + better GIDS clinicians + good mental health, + 'neuro-typical' + child in school, ++++++. Three painful years while the child's body is continuing in a puberty they do not want 22/

In practice, for reasons alluded to above, this is often longer, or sometimes tragically, never reached in the children's service. In 2016 a 17 year old died before they were able to access the care they wanted. Below CW: suicide 23/

The @Taviandport board papers which discuss the case state: "There was a delay in referral arriving from the referrer and a further delay as the referrer had confused us with adult services and waited results of blood tests before responding to our enquiries... 24/

..."By the time all paperwork was received, YP was past the stage to be seen by GIDS service before their 18th birthday. A letter was sent to the young person and their family explaining this and that they would need to be referred to adult services"....25/

"Sadly, the YP committed suicide and the GIDS letter was found in the young person’s bedroom".

"Sadly".
This is not sad. This is an inevitable consequence of the broken system I have just described.
26/

This is not the only death of a service user. May 2017, a patient, 15, who had attended 1st appointment at GIDS. Tavi board papers state: “A detailed risk assessment was not completed nor was the young person seen on her own"... 27/

It continues "Clinicians in the Gender Identity Service each have high caseloads with associated administrative workload”.

This is not sad. It is an inevitable consequence of a service which is not fit for purpose 28/

There have been 3 deaths I am aware of since 2016 of GIDS service users. When GIDS first published their "evidence base" in 2016, they stated that there had been 1 death, in a section on suicide. This was later amended to 3, & has since been removed (growinguptransgender.com/2016/11/11/gid…) 29/

One death is too many. Three is a clustershambles. I have not read of any of these incidents in any news coverage. Nowhere has the now THREE YEAR wait for hormone blockers been discussed. Instead we get the utter nonsense of KIDS GIVEN FAST TRACK SEX CHANGE DRUGS. 30/

This statement reportedly from an @NHSEngland clinician working for @TaviAndPort, the very service which is failing our kids with their slow, harmful, incompetence. the NHS is failing trans & gender diverse children young people & the current monopoly provision is a disaster 31/

A disaster, not because they are treating youth too fast, but the very opposite , it is a struggle to access any treatment whatsoever. What treatment is forthcoming requires hurdles across multiple barriers. The service is broken. Our children deserve so much better [MEGATHREAD/]

p.s. The above describes the route for blockers. Cross Sex Hormones are only available from GIDS after a minimum of 12 months on hormone blockers - (this is outside of the NHS service specification & the Endocrine guidelines which GIDS claim to follow) growinguptransgender.com/2018/07/20/gid…

pps. If you are having suicidal thoughts there is help available right now:
Samaritans - 116 123
Papyrus - 0800 068 41 41 (Text 07786 209697)
Childline - 0800 1111 (the number won't show up on your phone bill)

@CQCpressoffice #declareyourcare #nhsfailingtranskids

@fiercemum has just pointed out that if waiting times continue to increase at their current trajectory, then the wait for those referred today will be 37 months. This will lead to a 4.5 years. We have no confidence in GIDS' ability to reduce waiting times.

https://twitter.com/FierceMum/status/1099751564535873537