UK’s only gender identity service for children rated inadequate by CQC


An NHS mental health trust which provides treatment to transgender children has been rated inadequate by the Care Quality Commission (CQC), after inspectors found vulnerable young people “were waiting too long for treatment”.

Tavistock and Portman NHS Trust, which runs the UK’s only gender identity development service (GIDS) for children, was told by the health regulator it needed to significantly improve its services and waiting times, after it found more than 4,600 young people on the waiting list – with some waiting more than two years for their first appointment.

In response to the CQC report, the trust apologised to patients for the long waiting times and announced that it is bringing in experts from outside the service to help with improvements.

It comes after the trust paused new referrals for hormone treatment following a landmark High Court ruling in December over the use of puberty blockers.

The commission said it carried out the inspections in October at the GIDS clinics at the Tavistock Centre in London and in Leeds following concerns by healthcare professionals and the Children’s Commissioner for England over “clinical practice, safeguarding procedures and assessments of capacity to consent to treatment”.

General view of Tavistock Centre in London
General view of Tavistock Centre in London

In its report published on Wednesday, the CQC said: “Staff did not always 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.”

On how safe the service is, the CQC said it required improvement after it found high caseloads added pressure to staff, with one person found to be dealing with a caseload of more than 100 young people while 65% of staff had a caseload of more than 40.

The report states staff had only recently begun to clearly record the competency or capacity to consent for young people who might have impaired mental capacity.

It said: “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.

While the service was rated inadequate overall, the CQC praised staff for treating patients with “compassion and kindness”, and that they “respected their privacy and dignity, and understood the individual needs of patients”.

But it said staff “did not always feel respected, supported and valued”, and that the service was not consistently well-led.

Keira Bell
Keira Bell

Former patient Keira Bell, 23, who began taking puberty blockers when she was 16 before “detransitioning”, took legal action against the trust after she argued that children cannot properly consent to taking the treatment.

Two months after the October hearing, the High Court ruled children under 16 needed to understand “the immediate and long-term consequences of the treatment” to be able to consent to the use of puberty blockers.

Kevin Cleary, CQC’s deputy chief inspector of hospitals, said: “We identified significant concerns and took enforcement action by imposing conditions on the registration of the trust.”

He said concerns were fed back to the trust as well as NHS England and NHS Improvement, adding: “We were extremely clear that there were improvements needed in providing person-centred care, capacity and consent, safe care and treatment, and governance.

“In addition, vulnerable young people were not having their needs met as they were waiting too long for treatment.”

Following inspection, the trust is required to report to the CQC on a monthly basis so it can monitor the progress of improvements being made on waiting times.

A spokesman from Tavistock and Portman NHS Trust said: “We take the CQC’s report very seriously and would like to say sorry to patients for the length of time they are waiting to be seen, which was a critical factor in arriving at this rating.”

He said improvements are being made, adding: “We are already finalising plans to bring in senior clinical and operational expertise from outside the service to help us implement the necessary changes and consider how we can improve on current processes and practice – including how we standardise our assessment process.”