A national problem
The Care Quality Commission inspection report into the Tavistock and Portman NHS Foundation Trust Gender Identity Service has found it to be ‘inadequate’. It is a truly shocking read. It has identified multiple areas of concern.
We are appalled at the spin that this is just about waiting times. It is not. This is a national safeguarding scandal.
There are many questions that must be asked (and answered) about why so many children are experiencing distress around their gender in the first place. There has been an exponential rise from 77 referrals in 2009/10 to over 2700 in 2019/20. Most of these are girls.
What has gone wrong in our society? Why are we failing to challenge gender stereotypes? What are children looking at online? Are we adequately challenging sexism and homophobia in schools? What are children being taught in schools? We have seen many materials produced for schools which appear politically driven and could have contributed to this dramatic increase.
This regulatory capture in our society has gone so far that even the report into this scandal uses highly contested, ideological language such as ‘assigned sex at birth’. This must stop. Sex is observed and recorded at birth, usually by medical professionals. Mistakes are rarely made.
We are incredibly grateful to the children’s commissioner and all others who raised concerns. This has enabled this important Care Quality Commission inspection to take place. We are appalled at the inadequate standards of care and safeguarding revealed here. It is unacceptable that these very vulnerable children have been subjected to this.
Serious failings
The inadequate record keeping, more details of which have been exposed by the evidence in the Keira Bell case against the Tavistock, is verging on criminal in our view. Failing to work together with other professionals is a failing repeatedly found in Serious Case Reviews that have been carried out once children have been seriously harmed.
The fact that some staff said they ‘felt unable to raise concerns without fear of retribution’ is horrifying and certainly not conducive to the effective safeguarding of these vulnerable children. It is also disturbing that not all staff were up to date with mandatory training. If everybody was up to date with their radicalisation training it may have been easier for staff to be mindful of what children or their parents might have been viewing online.
It is essential that anybody working with children is up to date with all applicable safeguarding training and alert to at all times to any potential concerns. It is paramount that they feel supported to voice any concerns they have.
We find it bizarre that ‘a young person taking an overdose of over-the-counter medicines after their therapeutic session evoked traumatic memories’ and ‘a member of the public posting abusive messages about the service on social media’ are seen as comparable by both the service and the report. Both of these are described as ‘incidents’. Why is the suicide attempt not a serious incident?
Vulnerable children let down
Reading through this report, our shock increases on every page. Statements such as: “Staff had only recently begun to record consent and capacity or competence clearly for young people who might have impaired mental capacity or competence,” must not be allowed to overshadowed by concerns about waiting times. Sufficient attention must be given to the lack of appropriate record keeping.
The report states “the service provided an illustrated guide to puberty & hormone blockers for young people who may find it difficult to read detailed text.” We find it absolutely staggering that children who needed pictorial guides were ever deemed capable to consent to potential sterilisation.
This sentence, “There appeared to be no framework for discharge other than young people reaching the age of 18,” contravenes the claim that puberty blockers are merely a ‘pause button’. It would appear to suggest that once on the medical pathway all the children proceed to cross sex hormones. This was backed up by evidence heard in the recent Keira Bell case.
We would encourage people to read the report in full then support Keira Bell by either sharing or donating to the crowdfunder for her upcoming appeal.