Dr Carys Moseley comments on the recent news that the Tavistock Clinic has been rated as ‘inadequate’ in its care to young people.
Last week, it was revealed that the Care Quality Commission (CQC) had rated the Tavistock gender identity clinic for children and adolescents ‘inadequate’. This is ironic given that only a day beforehand the Tavistock had been given leave to appeal the High Court judgment on puberty blockers. The CQC inspectors said that their findings were based on the clinic’s legal position at the time of the inspection, held before the judgment in October and November 2020.
Priorities were wrong
The inspection report makes for sobering reading. As one journalist puts it, the whistleblowers have been vindicated. What is particularly noticeable is that the priorities of clinicians seem to have been inverted from what they should be.
On safety and effectiveness the service is said to require improvement. Inspectors rated it as ‘inadequate’ as far as responding to people’s needs and being well led were concerned. The only aspect deemed ‘good’ was that the service was ‘caring’. In other words, being polite and courteous to children referred (including using preferred pronouns) was of paramount importance. Actually tending to their medical and psychiatric needs, not so much.
Risk of self-harm
The inspectors found alarming evidence that teenagers waiting for help were at risk of harming themselves.
“Staff did not always assess and manage risk well. Many of the young people waiting for or receiving a service were vulnerable and at risk of self-harm. The size of the waiting list meant that staff were unable to proactively manage the risks to patients waiting for a first appointment. For those young people receiving a service, individual risk assessments were not always in place with plans for how to manage these risks. The number of patients on the caseload of the teams, and of individual members of staff, were high making caseloads difficult to manage and placing pressure on staff.”
No written consent given for puberty blockers
It seems that only the threat of a judicial review on puberty blockers had an effect on recording patients’ consent to ‘treatment’. The inspectors said this:
“Staff had not consistently recorded the competency, capacity and consent of patients referred for medical treatment before January 2020. However, since this date these decisions had been recorded.”
It is very important to realise that we do not know what lack of record of consent means. Does this mean puberty blockers have been prescribed without consent, or without proof of consent? If no written consent was given for puberty blockers, why was this? Perhaps if there are no surviving consent forms, clinicians cannot then be sued by those regretting treatment, as they would require evidence.
It should go without saying that the GIDS would have everything to lose by not ensuring that consent forms had been filled in for every patient. At any rate this surely undermines the entire legal defence the GIDS mounted against the judicial review on puberty blockers. That case was based on challenging the view that children can validly consent to such experimental treatment. Surely it also undermines the appeal that the GIDS has been permitted to mount against the High Court ruling.
Care plans not developed
In a perfect illustration of how being ‘kind’ is not the same thing as meeting patients’ needs, the inspectors criticised staff for not developing care plans for teenagers.
“Staff did not develop care plans for young people. Many records provided insufficient evidence of staff considering the specific needs of young people, such as autistic spectrum disorders.”
“Staff did not develop holistic care plans for young people. Records of clinical sessions did not include any structured plans for care or further action. Staff did not sufficiently record the reasons for their clinical decisions in case notes. There were significant variations in the clinical approach of professionals in the team and it was not possible to clearly understand from the records why these decisions had been made.”
No clear assessment process
The Care Quality Commission downgraded the effectiveness rating of the GIDS. The following reason was given:
“Our rating of effective went down. We rated it as requires improvement because: Staff’s assessments of patients were unstructured, inconsistent and poorly recorded. Staff did not sufficiently record their reasoning in reaching clinical decisions. There were significant variations in the clinical approach of professionals in the team and it was not possible to clearly understand from the records why these decisions had been made.”
Reading between the lines, it seems that staff did not agree on the right clinical approach to take. This is because it is an open secret that GIDS staff have differed for many years. Some believe physical treatments to aid transition are valid, others do not accept transition.
Inspectors were troubled by the lack of a clear assessment process for patients. As a result they argued the clinic would find it hard to assess whether they should have referred children for puberty blockers.
“Furthermore, there was no clearly defined assessment process. For example, there were no standard questions for staff to explore with young people at each session. Most records of assessment sessions were simply descriptions of conversations that had taken place between the clinician, the young person and their parents. None of the records included a clear statement of what the service was assessing. Whilst the criteria for considering referring young people for administration of hormone blockers was set out in the service specification, we saw no reference to this on any patient records. Although decisions about referrals to endocrinology were taken by at least two clinicians, it would be very difficult for the service to assess whether clinicians had made the correct decision in making a referral.”
Compromised by transgender activism
We have worked our way backwards here so to speak, from patients’ risk of self-harm through to lack of written consent, proper care plans or even clear assessment. This isn’t just a sign of incompetence. This level of disorganisation points to a deeper problem. The Care Quality Commission inspection report did not delve into possible reasons for these serious shortcomings. As hinted above, there needs to be a probe into the influence of transgender activism on the clinic.
Courtesy and kindness have been made more important than ensuring that treatment is morally right and protects vulnerable patients. This is exactly the mentality of transgender activists and their enablers. They lecture everyone on using preferred pronouns whilst deliberately campaigning to remove legal protections based on people’s sex. This is medically unethical and socially unacceptable on every level. Being kind and caring only has value if clinicians’ work is rooted in good medical ethics and a vision of a healthy mind in a healthy body. Otherwise it is deceitful sentimentality with disastrous consequences.
Staff feared retribution
The inspectors also looked into how staff worked with each other and whether they felt free to raise problems with those above them. The findings were very troubling and echo what whistleblowers have been saying.
“The teams did not always include the full range of specialists required to meet the individual needs of the patients. Staff did not always work well together as a multidisciplinary team. Staff did not always feel respected, supported and valued. Some said they felt unable to raise concerns without fear of retribution. The service was not consistently well-led. Whilst areas for improvement had been identified and some areas improved, the improvements had not been implemented fully and consistently where needed.”
Who did not respect staff and why? Who was the object of fear of retribution? There is a hint here about the senior management, yet the CQC does not probe further.
Problems go back at least sixteen years
Why did the CQC suddenly find problems in 2020? Apparently its previous inspection in 2016 was fine. Is it really credible that GIDS was doing fine in 2016? Or has there been a sudden change of approach at the CQC in lights of mounting public concerns?
Problems go back at least to 2005 as Dr David Bell’s report has shown. Christian Concern has seen the Bell report on the GIDS which the Tavistock tried so hard to withold from the BBC. Eventually the BBC went to the Information Tribunal and won the right to see an unnecessarily redacted copy of it. Having seen the full report, it is evident that the problems are not only long-standing but cut to the very heart of the GIDS. We have commented several times on the fundamental problem at the GIDS from its inception, namely that there was always openness about ‘treatment’. What this means is that staff seem to have been resigned to the fact that patients could always undergo ‘sex-change’ procedures once they were 18.
More than just waiting times
The Care Quality Commission is said to have begun enforcement action based on its report. It is said to be demanding updates every month of waiting list numbers. It also wants actions to bring the numbers down. This is where the report is weakest. For this is a transgender activist theme par excellence. It has been incessantly trotted out to the press without real scrutiny. Clearly the long waiting list is related to the high number of patients referred. Many argue that the answer to this is to recruit more therapists. Alternatively others say that more staff should be trained in local CAMHS teams. Neither option addresses the way in which transgender ideology has sown confusion and discord among therapists.
Given the poor reputation of the GIDS and the resignation of so many staff members, recruiting more clinicians is very doubtful. Serious clinicians would not want to work there. If the current backlash against puberty blockers continues, clinicians will be seen as tainted by association and become less employable elsewhere. At the same time, the fact that so few of the whistleblowers have revealed their names publicly is telling.
The professional ban on ‘conversion therapy’
Psychotherapists who blew the whistle and left the GIDS have a good reason not to reveal their names publicly. Most have gone to other posts in mental health institutions. Nearly all mental health professional bodies have signed the Memorandum of Understanding on Conversion Therapy, which bans therapy for unwanted same-sex attraction and gender identity. This means that currently any professional deemed to promote ‘conversion therapy’ could be disciplined by their professional body. Furthermore it means that such a professional would have nowhere else to go as no institution would risk employing them, for fear of being censured by the same mental health bodies.
I have previously written on how Marcus Evans, a former Tavistock director and whistleblower who was willing to go public, has criticised the Memorandum. He says that it has obstructed the possibility of doing good therapy with children and teenagers. When the High Court judgment was made on puberty blockers, I showed that neither the court nor journalists commented on the harmful effect of the Memorandum over the therapy practiced at the GIDS. The number of children referred to the GIDS has risen over the same period of time as the professional ban on ‘conversion therapy’ has been rolled out. Neither the court, nor journalists, nor the gender-critical movement nor the Care Quality Commission has been willing to investigate this properly. In our submission to the Women and Equalities Committee on the Gender Recognition Act, we recommend that the government rescinds this professional ban on ‘conversion therapy’. Only when that happens will therapists be free to develop the best possible care for these children and teenagers.
All roads lead to Stonewall
Despite its shortcomings, the Care Quality Commission report is timely, and extremely useful in undermining the Tavistock’s appeal of the High Court judgment. In and of itself however it does not ask the fundamental philosophical questions. This begs the question as to why. The bottom line is that the Tavistock clinic cannot realistically meet the demand of reducing waiting times without there being changes to staffing. We have seen how problematic that would be.
The Care Quality Commission is part of the Stonewall Diversity Champions Programme. It has been involved with this at least as far back as 2015, so before the last inspection of the GIDS in 2016. Stonewall has been closely involved with the development of the Memorandum of Understanding on Conversion Therapy all along. This could explain the more favourable inspection results back then. Certainly the fact that Stonewall offers training to such member organisations will have played a part. Thus we have to conclude that it has a vested interest in not asking the deeper questions about transgender ideology’s influence on the Tavistock. Indeed the fact that inspectors chose to highlight action on waiting times is a sign that they themselves are in thrall to transgender activism. Institutions involved in dealing with gender-confused children and adolescents need to be emancipated from Stonewall’s influence. Otherwise they will continue to fail to meet patients’ needs.
The GIDS stands defiant of all criticism
UPDATE: Since this article was first published on 26 January 2021 it was reported by Hannah Barnes from BBC News that the GIDS executive (leadership team) will be disbanded in light of the inspection report. This information was published in the papers of the meeting of the Tavistock trust board of directors held on that day. A new structure will be set up from 1 February and more clinical staff will be recruited from outside. Does this really mean the GIDS is changing direction? Hardly.
The paper says that change is needed due to several factors, including the 2019 GIDS review, the findings of the High Court in the judicial review against the GIDS, the Care Quality Commission report, the Tavistock trust’s current review and the new Cass Review into gender identity services for minors. Crucially however, the paper also says that the GIDS will develop ‘a new endocrine pathway’ (page 101). In other words, it will double down on referring children for puberty blockers and cross-sex hormones! It also promises to improve its record-keeping as far as consent is concerned. Of course it needs to provide the evidence for consent to the Court of Appeal that it could not really provide to either the High Court or the Care Quality Commission! Conveniently, this Friday, Stonewall, Mermaids, Gendered Intelligence, sexual health charity Brooke and the US Endocrine Society will seek permission to intervene in the appeal. The GIDS and its allies stand defiant in the face of all criticism.