Closure of the Tavistock Gender Clinic Announced

In July 2022, NHS England announced that the Gender Identity Development Service would close. This clinic, run by the Tavistock and Portman NHS Trust in London, was the only gender clinic for children and young people in England and Wales. The news report from that day has been archived as the BBC report on the closure; the broader policy is covered under gender care in the United Kingdom.

The Cass interim report

The catalyst was the interim report published by paediatrician Hilary Cass in March 2022. She concluded that having a single specialist clinic for the entire country was not a safe or sustainable long-term solution. The waiting list had grown to several years, while young people with additional issues such as autism or depression were receiving too little support for those problems.

Concerns about the clinic

Staff had previously warned internally and in the media that young people were being referred for medical treatment too quickly. The UK's healthcare regulator rated the clinic inadequate in early 2021. Around the same time, the legal case Bell v Tavistock was under way.

What replaced it

The clinic eventually closed on 28 March 2024, a year later than planned. Care was transferred to regional centres linked to children's hospitals. Paediatricians, psychiatrists and other specialists work together there, taking the young person's overall health into account.

The clinic's history

The Gender Identity Development Service was founded in 1989 by child psychiatrist Domenico Di Ceglie and moved to the Tavistock clinic in London in 1994. For many years, the service saw a few dozen children a year and mainly provided counselling and support. From 2011 onwards, as part of a study, the clinic also provided puberty blockers to young people under sixteen, following the Dutch example. This became standard practice in 2014. During the same period, the number of referrals rose from fewer than one hundred a year around 2010 to approximately five thousand in 2021 and 2022.

The whistleblowers

In 2018, psychiatrist David Bell, a member of the institution's board, wrote an internal report based on conversations with ten clinicians. They said they were under pressure to make referrals quickly and that other possible causes of young people's distress, such as trauma or struggles with homosexuality, were not being investigated sufficiently. In 2021, an employee responsible for safeguarding children won a legal case against the institution after being disadvantaged for passing on colleagues' concerns. Journalist Hannah Barnes described what happened in her 2023 book Time to Think.

The new model

The first two regional centres opened in April 2024, in London and in the north-west of England. They are linked to major children's hospitals. Referrals now go through a paediatrician or child and adolescent mental health services, rather than directly through a GP or a school. At the time of the transition, several thousand young people were on the waiting list.

Significance

After the announcement, a British law firm said it represented a large number of former patients who were considering bringing compensation claims against the institution. They argue that, as teenagers, they were referred for medical treatment too quickly and that other problems were not investigated sufficiently. Those cases are still ongoing. For clinicians elsewhere in Europe, what happened served as a warning: according to the investigations, the problems in London had less to do with the protocol on paper than with the pressure placed on a single clinic by a rapidly growing waiting list.

The Tavistock clinic had adopted the Dutch Protocol and was one of the largest gender clinics for young people in the world. Its closure showed that a country that had adopted the model could also reverse course. The final report followed in April 2024; see the Cass Review.