Public Policy Researcher Dr Carys Moseley comments on new rules for how the NHS treats children with gender distress
The NHS has published its new interim service specification for specialist gender services for children and adolescents.
It is aimed at the two new gender hubs that are to open in England. It is the outcome of its consultation on the matter last autumn, to which we encouraged supporters to respond.
This has been reported in the press as a positive development, mainly because puberty blockers will no longer be given routinely. However, they will still be given as part of a research project. The main approach required of clinicians towards children will change from affirmation of a chosen gender identity to ‘watchful waiting’.
The question is, will this new specification truly protect children, and improve on what happened before?
Don’t believe the hype
The first thing to say about this is ‘don’t believe the hype’. There have been too many times now when people have celebrated alleged victories over the trans agenda in institutions, only to find it being allowed to continue on the sly. The devil is often in the details.
The aims of the service are set out in section 7, which says that there will be individually tailored care plans for each child, with primarily a psychosocial focus. However it then says ‘the service will provide onward referral to endocrine services’. In other words the service will continue to refer children on to doctors who can prescribe puberty blockers. This is not surprising given the serious weaknesses of the ongoing Cass Review which I have already exposed.
Commissioned centres must take part in research
The two gender hubs intended for England are called ‘commissioned centres’ in the service specification. They will be linked to a new National Children and Young People’s Gender Incongruence Research Oversight Board. This in turn will develop research programmes which will look at the following issues:
“epidemiology; prediction; the course of gender querying; and outcomes of psychological treatments to reduce distress.”
The centres will have to take part in research run by the board. They must:
“Contribute to the identification of study and treatment evaluation priorities through participation in the National Children and Young People’s Gender Incongruence Research Oversight Board
Deliver research and evaluation programmes within the service and in partnership with other commissioned service providers
Ensure an enhanced data set is collected from assessment through to follow up to facilitate research and evaluation, including for those whom, following assessment, it is determined would not benefit from intervention by the Service.”
‘The best interests of the child’
The talk of individualised care plans for each child initially sounds appealing. It goes with talk of ‘the best interests of the child’, a slogan that has long been used by radical activists to drive a wedge between parents and children.
Exploratory approach putting children in the driving seat
This highly individualistic, children’s rights-centred approach, is why the specification says that a psychosocial approach is only to be the primary not the exclusive intervention available. Included in this is ‘psychoeducation’, explained as providing parents and local professionals with ‘information on gender identity development including research evidence’. It will also educate them on ‘how to support an exploratory approach that allows their child or young person time and opportunity to consider different options in a flexible and non-judgemental context.’ Family members will be able to access ‘facilitated group discussions with peers on a similar pathway’.
In line with the serious shortcomings of the Interim Cass Review, the meaning of key terms appears unclear. We are told that the main objective is:
“to alleviate distress associated with gender incongruence and promote the individual’s global functioning and wellbeing.”
However, this exploratory approach clearly makes the child not the parents the authority over treatment, and as such privileges the moral judgment of immature minors over those of mature adults. This will not really improve children’s functioning and wellbeing.
Puberty blockers and cross-sex hormones will continue
In the very next sentence we are told this:
“The approach for onward referrals to endocrinology clinics are described in separate NHS England clinical commissioning policies for puberty suppressing hormone treatment and gender affirming hormone treatment.”
So far, absolutely nothing whatsoever has changed. In fact, things have got worse. In the section headed ‘Prescribing from unregulated sources and unregulated providers’, it is said that the NHS will actually consider assuming responsibility for puberty blockers if the young person started taking them from an unregulated source, i.e. from unscrupulous online providers.
“If a child or young person has already been started on puberty suppressing hormones outside of NHS protocols by the time that they are seen by the NHS, The Service may consider assuming clinical responsibility for prescribing through NHS protocols if The Service’s MDT [Multi-Disciplinary Team] jointly concludes with the related endocrine clinic that this is an appropriate harm reduction measure.”
This is blatantly allowing puberty blockers through the back door.
Social transition ‘should be led by the young person’
As may have been guessed from the quote above, the specification actually says that ‘social transition should be led by the young person’. This is nothing short of enthroning the child as king or queen.
By way of a brief and perhaps merely academic concession, the specification says at one point that ‘social transition is not neutral’.
Psychological support will be biased
The service specification promises that there will be psychological support, or ‘intervention’ as it says. However this will not be for all children referred.
“Direct psychological support by the service will focus on children whose presentations are persistent.”
In other words it will help those who insist that they are members of the opposite gender. What we are seeing here is the pernicious effect of the existing professional ban on ‘LGBT conversion therapy’. This ban, written down in the Memorandum of Understanding on Conversion Therapy in the UK (MOU), prohibits therapists from preferring one gender identity over the other. What this means is that a therapist cannot tell a client that they would be better off living as a member of their biological sex. Consequently, a child who persists in presenting themselves as a member of the opposite gender will have to be affirmed as such.
No mention of biological sex
There is a particularly glaring omission from this interim service specification. At no point is it suggested that the family should routinely treat the child as a member of his or her sex. Indeed, biological sex is never once mentioned.
This shows how the NHS is ultimately unwilling to challenge and confront transgender ideology.
Lack of curiosity about origins of gender distress
Overall, this new interim service specification is not a vast improvement on what came before. It is based on the exploratory approach, sometimes called watchful waiting, and thus places the child as king. It never suggests that clinicians should question parents as to the origins of the child’s problems.
It thus tacitly colludes with parents who have engineered the child’s gender confusion. This is not particularly surprising when considered in light of the serious weaknesses of the ongoing Cass Review.
Will unscrupulous parents game the system?
The mixed messages given about ‘endocrine interventions’, i.e. puberty blockers and cross-sex hormones, beg serious questions. At present, the press comment implies puberty blockers will be out of the picture.
However, parents who really want their children to transition are bound to ask for them to be allowed to take part in the planned research on puberty blockers.
Will children be protected under the new system?
It is therefore not evident that the new interim service specification will protect children. We must remember that a new national policy is yet to be published. Will that one draw on this one? The service specification is clearly far too sympathetic to transitioning minors, despite making some cautionary noises. All who are concerned about the welfare of children will need to monitor very closely and challenge what goes on in the coming months.