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London Trans+ Pride March 2022Photography Eerie

NHS England is expanding services for trans youth

The opening of two new departments with a focus on the mental health of trans children, is undoubtedly a move towards better trans healthcare in this county

Yesterday, NHS England announced that it will be expanding services for trans children in the UK by opening two trans-specific departments in dedicated children’s hospitals by spring 2023. One centre will be in London, provided by a partnership between Great Ormond Street Hospital for Children and Evelina London Children’s Hospital, while the other will be in the north-west, provided jointly by Alder Hey Children’s NHS Foundation Trust and Royal Manchester Children’s Hospital, with both focusing on the mental health of children accessing the service.

This comes in response to the independent Cass Review, which looks at the current service provider, the Tavistock Clinic in London. Although set for publication next year, Dr Hilary Cass has made the recommendations that are to be implemented through her Interim Report in February 2022 and letters to the NHS. The review is highly critical of the processes and care provided by Tavistock, citing spiralling waiting lists of over 5,000 patients, the deterioration of the mental health of those patients, and ultimately finding that the current system cannot deal appropriately with the volume of people being referred. As such, Dr Cass has recommended that NHS England close the Tavistock Clinic and move to a “fundamentally different” service model.

This is something trans people have been talking about for years – trans people in the UK, including children, should not have to wait years to see a specialist and the disastrous impact of those waiting lists on the mental health of trans people across the country. Stonewall reported in 2017 that 84 per cent of trans young people have self-harmed, and 45 per cent have attempted to take their own life. This is a very real and serious problem, caused in part by a lack of access to services for young people; so the move to regional centres, removing the need for children across England to travel to London for every appointment (one parent referenced repeated four-hour round trips), and an increase in capacity to reduce waiting lists (so that seeing a specialist might actually seem like a reality), and a focus on the mental health of trans children, is undoubtedly a move towards better trans healthcare in this county.

But to look at the headlines surrounding the announcement, you might have missed this. Every headline in the UK press (with the notable exception of The Independent) focused on the closure of The Tavistock Institute, the current service provider, calling it “unsafe”, citing “safety fears”, “tragic consequences” and “damaged children” without contextualising these quotes as being caused by the insufficiencies of the current service, and the solution to these problems being an expansion of the service, not cessation. In short, they spun it against trans people – exactly as they always do.

What they have spun is a web of ideas that trans children are being “rushed” through these services, with the Kira Bell case sitting at the centre of that idea. Today, in the wake of the announcement, both candidates for PM decided to weigh in on the news in line with the headlines. Rishi Sunak’s team stated that “children should not be rushed down irreversible medical pathways,” leaving anyone who read about the 5,000-person and years-long wait wondering who exactly is being rushed? (Oh, and there aren’t any irreversible treatments being offered to children.) And Liz Truss, true to form, made the promise to ensure “checks and balances” (as she has every time she is asked about trans healthcare), despite those “checks and balances” being a large part of the reason for the length of the waiting lists. More dangerously, she called for the need to “protect” and “shield” children from transitioning, and continues to position doctors as more reliable than trans people when it comes to knowing if they are trans. Despite claims made by The Telegraph, neither of them mentioned hormone blockers.

Wading through all these distorted and prejudiced takes can be difficult, so I want it to be clear to anyone reading this that this announcement is a good thing for trans people. Our complaints about the way trans healthcare is delivered are finally being taken seriously; they are being written up on NHS letterhead and solutions are being implemented. Let’s not forget that the catalyst for this review was the suicide of an 18-year-old trans man who, after being referred at 16, was given a further 22-month wait to see a specialist. (Remembering that under the NHS Constitution, those referred to a specialist have the legal right to be seen in no more than 18 weeks.) The service is failing young trans people, the wait lists are unacceptable, the mental health of trans people is being neglected. The focus now needs to be on ensuring that these new departments listen to trans people when considering the structure and services they offer, medical treatments are uninterrupted during the process and that care is centred on the needs of trans children.