Thread by @hannahsbee

Afternoon session at Royal Courts of Justice has begun in Keira Bell v Tavistock and Portman NHS Foundation Trust

Barrister for claimant explains that it is always precedent that the court takes into account the wishes and autonomy of the child.

But it is always job of court to protect the child while at the same time giving as much respect as possible to the child’s autonomy.

Lengthy discussion of consent and Gillick competency taking place. I should say, the sound is pretty bad so it’s not possible to hear everything clearly.

Claimants argue that there is some precedent where even if the court is satisfied that gillick competency is achieved, the court’s jurisdiction to override that consent remains.

Argument is made that one can only answer question of competence by understanding the information that needs to be given for that decision. And if that information is of a nature that’s not possible to understand, then gillick is not met.

Determination of competence must be child specific and circumstance specific. Lack of competence in one context does not preclude competence in another area, it’s argued.

There is a distinction to be drawn, claimants say, between competence and informed decision-making. Two questions need to be asked a) is this child competent? b) if yes, can they give informed consent in this context?

Argument being made is that while child or YP maybe competent, they cannot give informed consent to treatment with puberty blockers due to their alleged long term impact

Family Law Reform Act is cited - we’re told this gives presumption of capacity in children over 16 in respect to medical treatment. Claimants say that even in these circumstances, it can be overridden by a court while the child remains a minor.

Judge questions how the case of a 16 year old deemed competent, with parents who support treatment with blockers, and a clinical team content with it, would come to court

Apologies, I cannot hear the questions of the judges clearly enough to be able to write

Judge now questioning what proportion of Tavistock’s patients who start blockers go on to cross sex hormones. Is it as high as 98% as per Dutch findings? It’s not possible to hear answer clearly. The court is trying to sort out.

Apologies, we are unable to hear responses from Tavistock’s legal team at all. It has been reported to the court

We have sound, albeit not amazing. Tavistock barrister - on individuals not competent or capable, we don’t have data but can give anecdotes and examples of individuals in that position. Also instances where some have been found not to be competent 1/2

At second stage of process. This shows robustness of process involved.

Continual monitoring and screening of whether there is adequate competence for consent, Tavistock say

Question to Tavi had been ‘has there been an instance where a YP had been refused blockers because they are not gillick competent?’

Tavistock is commissioned by NHSE. They follow the service specification set out and are acting within international consensual clinical frameworks. And also regulatory frameworks. Tavistock regulated by CQC, doctors by GMC and psychologists by other bodies.

So work down by clinicians at Tavistock is within this complicated framework

Tavistock says claimants are arguing for a radically different position to the current stance. This runs counter to Mental Capacity Act and securely established common law set out in GIllick by House of lords, and some startling requests for jurisdiction of court

Tavistock do not accept claimants’ arguments regarding sexual functioning or progression to cross sex hormones

Defendants commenting on Cass/NHSE review in conjunction with NICE on evidence available as to efficacy of treatments for gender dysphoria. That review, if it reveals important changes, will impact on service provided and shape the service specification

Referrals to endocrinology by GIDS does not always lead to a prescription for puberty blockers. It is a two stage process, Defendants say

Service specification does not shy away from important questions. At each stage of treatment consent gained. No shying away from talking through w individuals what later treatments might involve; acknowledged that long term impacts unknown and that some will go on to CS hormones

Defendants say service is holistic and tailored to the need of the individual. Insist that referral to endocrinology is not for treatment, but rather further assessment and consideration.

Any YP wishing to go onto cross sex hormones - having been on puberty blockers for some time - will undergo a separate assessment process, Tavistock claims

Endocrinologists prescribing the medication (puberty blockers) take personal responsibility for the decision, defendants explain.

There is sophistication in the consent process taken by the Tavistock Trust, defendants says

Tavistock barrister says NHSE service specification requires GIDS to act in line with WPath guidelines and therefore not possible to deviate from those without being in breach of contract with NHSE...

At moment, ‘like it or not’, that’s what GIDS told you comply with. And nothing radical about that - they are responsible guidelines made by responsible clinicians, defendants say.

At assessment there will be discussion about sexual preferences and future relationships. It’s not the case they are shied away from, it’s said.

Can’t make global statement - as claimant does - that any child of any age is incapable of understanding important issues. That’s why assessments are individual. And some of these YP are sexually active, defendant says.

Tavistock barrister says that one of the criteria for puberty blockers is that tanner stage 2 is reached, so can speculate that there is the beginning of sexual feelings. Fact remains that some people remain uninterested in sex throughout their lives.

Judge says you can’t assume a given 10 year old will be one of those people. Tavi barrister says that’s why there’s ongoing dialogue. Also, while convening for claimant to focus on younger patients, most are 15

End of day 1