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”.

BREAKING: The BMA press office have released a statement accusing the New Statesman article as being misleading. Needless to say I absolutely reject this and will show why. The statement does not say how Council members voted on the motion to ‘disavow’ the Cass Review 🧵 Instead, the BMA press office say:
“The BMA will continue with further work in this area to contribute positively to the provision of care and services to this often neglected population and will be setting out the BMA’s stance in due course.”
More to come …

EXCLUSIVE: in one of the final actions of Parliament, just before dissolution, the Government had legislated to ban private prescriptions (originating in UK or abroad) of puberty blockers for under 18s. NHS prescriptions will be restricted - legally - to official trials. Under 18s already receiving puberty blockers from the NHS will not be affected. Those receiving from abroad will no longer be able to. NHS prescriptions of GnRH analogues (blockers) NOT for treatment of gender incongruence for under 18s, are unaffected.

Extraordinary details in this case from the family court, highlighting just how badly gender-questioning young people are being let down: lack of NHS provision has led them to private providers. Here there was no physical examination before prescribing… bailii.org/ew/cases/EWHC/… “Dr Hewitt's principal criticism of Gender GP's intervention, however, relates to the dose of testosterone that was prescribed….[it] was at the level that one would administer to an adult only after a course of treatment … built up …over the course of two or three years.”

I wrote in this week’s @NewStatesman about the entirely false claim being spread by some that the Cass review excluded 100 studies on puberty blockers and hormones to reach its conclusion. The report and systematic reviews set out clearly what they’ve done… Today, Dr Cass tells the Times, “If you deliberately try to undermine a report that has looked at the evidence of children’s healthcare, then that’s unforgivable. You are putting children at risk by doing that.”

Health Secretary Victoria Atkins making a statement on Cass Review on gender identity services for children says: "professionals were not asking the right questions of themselves or of their patients" Praises Hilary Cass and her team, who have "meticulously unpicked what went wrong, what the evidence actually shows, and how to design a fundamentally different service that better serves the needs of children."

NEW: NHS England has announced that new youth gender services will provide masculinising and feminising hormones to children from ‘around their 16th birthday.’ This goes further than GIDS ever did: YPs cld only access hormones at 16 if they’d been on puberty blockers for 1 year🧵 Just last week, it seemed that the new services would have no medical pathway, with NHSE ending the routine prescription of puberty blockers. Today’s announcement, which was not put out to consultation, appears to signal a move in the opposite direction.

NEW: Today's announcement from NHS England on ending the prescription of puberty blockers for children with gender-related distress goes further than before (we've known of their intention to end their use in routine clinical practice for a while) 🧵
news.sky.com/story/children… NSHE consulted on plans to only allow the prescribing of puberty blockers as part of clinicals research or in 'exceptional cases' last summer. Today they've said there will no exceptional cases, as it wouldn't be workable in practice...

As more information comes to light on WPATH, English health authorities have sought to distance themselves from the organisation. The Dept of Health told the Mail NHS England ‘moved away from WPATH guidelines more than five years ago’.... Some context 🧵

dailymail.co.uk/news/article-1… It's true NHSE has said WPATH was irrelevant to its recommendation that puberty blockers no longer be part of routine clinical practice: 'NHS[E] does not commission based upon guidelines or treatment protocols eg WPATH 8.0 or practices in other countries' tinyurl.com/26afb54h

NEW: NHS England yesterday published more details on plans to only allow young people with ‘early onset’ gender dysphoria to be prescribed Puberty Suppressing Hormones (PSH)/ blockers as part of a clinical trial. It’s opened a consultation on the plans to run until 1st Nov.(🧵) We do learn a few new things from the various documents published as part of the consultation (all found here: )...shorturl.at/CFZ02

NEW: NHS England has confirmed puberty blockers for young people with gender incongruence will only be administered as part of clinical research. It comes as NHSE publishes the service specification that will guide the new gender services that will replace the Tavistock’s GIDS NHSE says it will propose: “outside of a research setting, puberty suppressing hormones should not be routinely commissioned for children and adolescents who have gender incongruence/dysphoria.”
tinyurl.com/35zc29zs

(🧵As Mermaids is trending, perhaps worth pointing out: It has never been secret that they were allowed to directly refer to Gids. So cld other third sector groups. But Tavistock emails suggest this first seems to have happened in 2014, not 2016 with new service specification. We’ve known since 2019 of direct emails between Susie Green and gids director Polly Carmichael and other board level members of Tavistock Trust: these were part of Mermaids’ data breach in 2019. Made it surprising when Tavistock said they didn’t have anything. From my book:

Hi @Waterstones, just wondered if you knew when Time to Think will start arriving in your stores? It’s just you’ve had hundreds & hundreds of copies in your warehouse for weeks, but people can’t currently buy one in Wales, all of Surrey, or most of the UK’s major cities🧵 None showing in your Manchester, Birmingham, Edinburgh, Glasgow, Leeds, Bristol or Oxford stores. In London, unlike all other Sunday Times bestsellers of the past fortnight (+plenty of others), which are in majority of your 30+ London stores, Time to Think is in less than 20%.

Many people have sent kind messages over the last 24 hours about mine and others’ reporting of GIDS. Thank you. To echo the sentiments of my former colleague Deb, though, our coverage has really just been about asking the same questions of GIDS as other NHS services… 1) What is the evidence base for this treatment?
2) Is the treatment on offer working for everyone?
3) Are the clinical and safeguarding concerns raised by staff being listened to? And how is the organisation responding to them?

NEW: The High Court will hear a challenge to the current treatment provided by NHS gender identity clinics – for both young people and adults. Claimants argue waiting times for treatment and ‘other failures in trans healthcare services, are discriminatory and unlawful.’ 🧵1/9 The Good Law Project, along with trans-led organisation Gendered Intelligence, two adult claimants and two child claimants have been granted permission to take their case to Judicial Review. 2/9
goodlawproject.org/update/trans-h…

NEW: A review of the governance of the Tavistock and Portman Trust, which is responsible for the Gender Identity Development Service (GIDS), has found 'multiple' issues and recommended leadership arrangements be strengthened. [1/10]🧵 The report's authors say that “the scale of the corporate governance issues we have identified across the Trust are multiple.” The external report is contained in this month’s board papers, which have now been removed from online. [2/10]

THREAD: The Court of Appeal has overturned a judgment handed down by the High Court that said under 16s were unlikely to be able to give informed consent to treatment with puberty blockers, and that each case should be heard by a court.
BBC copy here:
bbc.co.uk/news/uk-585981… The Tavistock and Portman Trust appealed the original judgement, saying the guidance given by the High Court ‘was wrong in law.’ Today, the Court of Appeal agreed that the original judgement went beyond the remit of the court and that ‘the claim for judicial review is dismissed.’

THREAD: Sonia Appleby, child safeguarding lead for the Tavistock and Portman NHS Foundation Trust, has been awarded £20,000 in damages, after employment tribunal rules she was subjected to ‘detriment’ after blowing the whistle on safeguarding concerns.
bit.ly/3tdEtHr Sonia Appleby had raised concerns about safeguarding in the Trust’s Gender Identity Development Service, after a number of clinicians had been to see her with their worries on several occasions.

THREAD: DAY 8 (FINAL DAY) – Sonia Appleby v Tavistock and Portman Trust employment Tribunal

SA - Sonia Appleby
YG - Yvette Genn, Tavi counsel
AP - Anya Palmer, SA counsel
EJG - employment judge Goodman This morning both sides' counsel have made written submissions and will be giving their oral submissions before the tribunal

THREAD: DAY 7 – Sonia Appleby v Tavistock and Portman Trust employment Tribunal

SA - Sonia Appleby
YG - Yvette Genn, Tavi counsel
AP - Anya Palmer, SA counsel
EJG - employment judge Goodman Before what's set to be a busy day of witnesses, perhaps a helpful thing to clarify: Dr Sinha explained several times that he interviewed 31 people for his review of GIDS. It's perhaps worth noting that these weren't all members of GIDS staff, as stipulated by terms of reference

THREAD: DAY 6 – Sonia Appleby v Tavistock and Portman Trust employment Tribunal

SA - Sonia Appleby
DS - Dr Dinesh Sinha, Tavistock Medical Director
YG - Yvette Genn, Tavi counsel
AP - Anya Palmer, SA counsel
EJG - employment judge Goodman

Questioning of DS by AP continues AP refers DS to an email sent following his review email