NEW: A judgement has been handed down by Family Division of the High Court this morning on question whether, in light of Keira Bell ruling on under 16s being ‘unlikely’ to provide informed consent to puberty blockers, parents can consent on their behalf. @deb_cohen 1/
It’s a thorough and complex judgement, but here are some points.
1) Parents CAN give consent: Whether or not a child can provide consent to blockers, “parents retain the parental right to consent to that treatment,” judge said. PBs should not have a special exemption. 2/
Mrs Justice Lieven: “The factors identified in Bell, which I fully agree with, do not justify removing the parental right to consent. The gravity of the decision to consent to PBs is very great, but it is no more enormous than consenting to a child being allowed to die...” 3/
“Equally, the essentially experimental nature of PBs should give any parent pause for thought, but parents can and do routinely consent on their child’s behalf to experimental treatment, sometimes with considerable, including life-changing, potential side-effects.” 4/
2) The case in question here has a particular set of circumstances: there is no disagreement between any of the parties. Parents, young person, GIDS clinicians and UCL endocrinologist all agree with the use of the blocker. 5/
3) Additional safeguards: Judge argues there MAY be need for additional safeguards. In current set-up “it may be that clinical difference and disagreement will not necessarily be fully exposed” and thus difficult for parents “to be given a truly independent second opinion.” 6/
But, any requirement for an independent second opinion, the judge said, is a matter for the regulatory bodies NHS England and Care Quality Commission - and “may be a matter considered by the Cass Review.” 7/
4) There could still be a role for the Court in these decisions: Judge states that “if the clinicians, or indeed any one of them, is concerned that the parents are being pressured to give consent [by child], then I have no doubt such a case should be brought to Court.” 8/
“Equally, if the clinicians consider the case to be finely balanced, or there is disagreement between the clinicians, then the case should be brought to Court." 9/
5) What’s next: It’s unclear what the practical impact of today’s judgement will be on children and young people already being treated with puberty blockers. That’s likely to be a question for NHSE. You can read the full judgement here: judiciary.uk/wp-content/upl… 10/10

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More from @hannahsbee

29 Jan
This morning there was a preliminary hearing of the Bell v Tavistock appeal (re: whether young people can give informed consent to treatment with puberty blockers), where the court decided whether there could be any new interveners in the case 1/
The hearing confirmed that those who intervened in the original case – University College London Hospitals Trust, Leeds Teaching Hospitals Trust, and Transgender Trend – would all be allowed to do so again in the appeal. 2/
In response to a joint application made by Stonewall, Gendered Intelligence, the Endocrine Society and Brook – the court ruled Stonewall were not granted permission to intervene, but the remaining three have been. Association of Lawyers for Children will also be interveners. 3/
Read 7 tweets
26 Jan
NEW:Tavistock Gender Identity Development Service (GIDS) Executive - leadership team - to be ‘disbanded’ in response to CQC’s ‘inadequate’ rating of service & decision in Keira Bell judicial review on whether under 16s can consent to treatment with puberty blockers @deb_cohen 1/
“In response to the CQC report and the breadth of existing actions flowing from the Judicial Review judgment we are proposing to take immediate action to strengthen management arrangements for the service and increase our clinical and operational capacity to deliver change” 2/
This will see “a new Interim GIDS Management Board, chaired by the Divisional Director for Gender. This will replace existing senior management structures in GIDS and will provide a single point of accountability for both improvement programmes and existing service delivery.” 3/
Read 8 tweets
20 Jan
NEW: Tavistock’s Gender Identity Development Service rated ‘inadequate’ by CQC after inspecting GIDS in autumn. CQC say inspection prompted by concerns reported by healthcare professionals & Children’s Commissioner, who’d been given evidence by me&@deb_cohen for @BBCNewsnight. 1/
This is a long thread. Bear with it if you can. Inadequate is the CQC’s lowest safety rating. This means that a service is ‘performing badly.’ GIDS’ smaller clinic based in Leeds was also rated inadequate. GIDS had been rated good at its previous CQC inspection in 2016. 2/
Since then, concerns have been raised about the service: @BBCNewsnight revealed how some GIDS staff had raised serious concerns about safeguarding, the speed of assessments, and whether patients’ other difficulties were always adequately explored. tinyurl.com/y7frzsr6 3/
Read 43 tweets
8 Oct 20
Court has resumed after lunch. Barrister for endocrinologists explains:
For UCL, median age for blockers 14.6, for cross sex hormones 17.4, youngest 10
For Leeds, median age for blockers 16, cross sex hormones 17.2, youngest 12
Of 145 patients referred to Leeds, 38 experienced delays to treatment. On two occasions pressure was seen to be coming from parent and choice not freely made. Barrister says evident there is no immediate access to treatment after referral
Barrister for endocrinologists says the relevant information on risks/benefits is very different for stage 1 (blockers) and 2 (cross sex hormones). ‘It’s no answer to say the majority of patients do go from stage 1 to stage 2.’
Read 33 tweets
8 Oct 20
WPath guidelines say puberty blockers are not a ‘nice to have’ defendants say.
Defendant says ‘time to think and alleviate distress’ is absolutely accurate way of describing purpose of puberty blockers
Judge quotes HRA investigation. Tavistock disagrees with HRA assessment.
Read 49 tweets
7 Oct 20
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.
Read 36 tweets

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