NEW: A damning letter from Dr Hilary Cass to NHS England bosses, detailing serious concerns about adult gender clinics has been published. NHSE haven't drawn attention to it, instead releasing an update on implementation of Cass’s recommendations for children’s gender services.🧵
The most common concern of staff at clinics was “the very limited time for assessment and the expectation that patients would be put on hormones by their second visit.” First appointments wld often be with someone “not necessarily clinically trained”.
Majority of patient presentations “were extremely complex, with a mix of trauma, abuse, mental health diagnoses, past forensic history, ASD and ADHD, & therefore this limited assessment was inadequate." These issues weren't taken into account in decisions to prescribe hormones.
Clinicians said it was difficult to say ‘no’ to prescribing hormones, even when there was "significant unstable mental health." Clinicians could be subject to complaints if they delayed putting patients on hormones, or 'clamped down on' if they offered too many appointments.
“consent procedures were inadequate”, with ltd explanation of physical risks and irreversible side-effects. Cass told that the psychiatrist who provided 2nd opinions for surgery at one clinic "writes ‘boilerplate’ letters" which "do not reliably reflect the individual patient".
Waiting lists were described as “out of control” & patients had extended periods without monitoring blood tests. “Suicides of patients on treatment were not formally discussed," & lessons not learned, Cass told. In one clinic “regret was treated as a new episode of dysphoria.”
Some gender clinic staff told Dr Cass that the approach taken was “ideologically driven and polarised and it was difficult to question the approach or discuss concerns.” There was a philosophy “that it was up to patients to make their own mistakes.
Workloads were described as “unmanageable”, with some holding responsibility for “many risky patients”, and leaving the service as a result. “Medical practitioners who left... described doing so because they were worried that they could not defend their clinical practice.”
I'm struck by just how similar these are to the serious concerns raised by GIDS clinicians – the Tavistock’s now closed service for children & young people. NHSE confirmed today that Dr David Levy will begin his review of adult services in Sept 2024. england.nhs.uk/long-read/nhs-…
Dr Cass's full letter to John Stewart and Prof. James Palmer can be read here: england.nhs.uk/wp-content/upl…
• • •
Missing some Tweet in this thread? You can try to
force a refresh
