England to Open Six New Gender Clinics for Children by 2026 with Stricter Referral Criteria: A New Model of Care by the NHS

Introduction

In a significant development that is likely to impact the future of gender healthcare in the UK, the National Health Service (NHS) has announced plans to open six new gender clinics for children by 2026. This move comes in response to the growing demand for gender identity services and follows a revealing report that highlighted the need for a “fundamentally different and safer model of care” for young people experiencing gender dysphoria. The new clinics will operate under stricter referral criteria, aiming to balance the increasing need for specialized care with the necessity of safeguarding young patients.

This article will explore the background of this decision, the details of the new clinics, the implications of the stricter referral criteria, and the potential impact on children, families, and the wider healthcare system in England.

Background: The Growing Need for Gender Identity Services

In recent years, there has been a marked increase in the number of children and adolescents seeking support for gender dysphoria, a condition characterized by a strong and persistent identification with a gender different from the one assigned at birth. This surge in demand has led to considerable strain on existing gender identity services in England, with long waiting times and concerns about the quality and safety of care provided.

The Tavistock and Portman NHS Foundation Trust, which currently operates the only gender identity development service (GIDS) for children in England, has been at the center of this controversy. In 2020, an independent review led by Dr. Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, was commissioned by NHS England to evaluate the service. The Cass Review, published in 2022, highlighted significant shortcomings in the existing model of care and made several recommendations for reform.

The Cass Review: Key Findings and Recommendations

The Cass Review was a comprehensive assessment of the GIDS and the broader landscape of gender identity services for children in England. The review’s findings painted a concerning picture of a system under immense pressure, with inadequate resources and insufficient oversight. Key issues identified in the review included:

• Long Waiting Times: Many children were waiting years to access care, leading to significant distress and potential worsening of their mental health.
• Inconsistent Care Pathways: The review found considerable variation in the quality and approach to care across different regions, with some children receiving inadequate assessments and support.
• Lack of Research and Evidence: There was a notable absence of high-quality research to guide clinical practice, particularly regarding the long-term outcomes of medical interventions such as puberty blockers and hormone therapy.
• Safeguarding Concerns: The review raised concerns about the potential for irreversible medical interventions being initiated without sufficient psychological support and consideration of alternative approaches.

In response to these findings, the Cass Review made several key recommendations, including:

1. Establishing New Regional Clinics: To reduce waiting times and ensure consistent care, the review recommended the establishment of new regional clinics across England.
2. Implementing Stricter Referral Criteria: To ensure that only those who genuinely need medical interventions receive them, the review called for stricter referral criteria and a more thorough assessment process.
3. Prioritizing Psychological Support: The review emphasized the importance of psychological support as the first line of care, with medical interventions considered only after a comprehensive assessment.
4. Promoting Research and Evidence-Based Practice: The review stressed the need for more research into the outcomes of different treatment pathways, particularly the long-term effects of medical interventions.

The New Clinics: A Regional Approach to Gender Identity Care

In line with the Cass Review’s recommendations, the NHS has announced the establishment of six new gender clinics for children by 2026. These clinics will be strategically located across England to ensure that all young people, regardless of where they live, have access to timely and consistent care.

Locations and Accessibility

The six new clinics will be situated in major cities across England, including London, Manchester, Birmingham, Newcastle, Bristol, and Leeds. Each clinic will serve a specific region, reducing the need for children and their families to travel long distances for care. This regional approach is designed to alleviate the burden on the Tavistock clinic, which has been overwhelmed by the sheer volume of referrals in recent years.

A Multidisciplinary Approach

The new clinics will adopt a multidisciplinary approach to care, involving teams of specialists in psychology, psychiatry, endocrinology, and social work. This approach is intended to provide a more holistic assessment of each child’s needs, ensuring that all aspects of their mental and physical health are considered before any decisions about medical interventions are made.

Comprehensive Assessments

One of the central features of the new clinics will be the implementation of more rigorous assessment processes. Every child referred to a clinic will undergo a comprehensive evaluation that includes psychological assessments, family interviews, and medical examinations. This thorough approach is designed to ensure that only those children who genuinely need medical interventions, such as puberty blockers or hormone therapy, receive them.

Focus on Psychological Support

Reflecting the Cass Review’s emphasis on psychological support, the new clinics will prioritize mental health services as the first line of care. Children experiencing gender dysphoria will be offered a range of psychological interventions, including individual therapy, family therapy, and group support. The aim is to provide these young people with the tools they need to explore their gender identity in a safe and supportive environment before considering any medical interventions.

Stricter Referral Criteria: Ensuring Safer and More Appropriate Care

A significant change accompanying the establishment of the new clinics is the introduction of stricter referral criteria. These criteria are designed to ensure that only those children who meet specific clinical guidelines are referred for medical interventions. The goal is to reduce the number of unnecessary medical treatments and to ensure that all decisions are based on the best available evidence.

The New Criteria

The stricter referral criteria will include several key components:

• Age Restrictions: Children under the age of 16 will only be considered for medical interventions in exceptional circumstances. This age threshold is intended to allow more time for psychological support and exploration of gender identity before considering irreversible treatments.
• Psychological Assessment: All children must undergo a detailed psychological assessment to rule out other mental health conditions that may be contributing to their experience of gender dysphoria. This assessment will also explore the child’s understanding of the potential risks and benefits of medical interventions.
• Informed Consent: Informed consent will be a critical component of the new referral process. Children and their families will be provided with comprehensive information about the potential outcomes, risks, and uncertainties associated with medical interventions. This will include discussions about the possibility of regret and the need for lifelong medical care following treatment.
• Parental Involvement: The involvement of parents or guardians in the decision-making process will be mandatory. The new criteria recognize the importance of family support in ensuring the well-being of children undergoing treatment for gender dysphoria.
• Multi-Disciplinary Team Approval: Before any medical intervention is initiated, the case must be reviewed and approved by a multidisciplinary team of specialists. This team will consider all aspects of the child’s physical and mental health, as well as their social and family circumstances.

The Impact of Stricter Criteria

The introduction of stricter referral criteria is expected to have a significant impact on the number of children receiving medical interventions for gender dysphoria. While some may view this as a potential barrier to care, the NHS believes that it is a necessary step to ensure the safety and well-being of young people. By ensuring that only those who genuinely need medical interventions receive them, the NHS aims to reduce the risk of regret and ensure that all decisions are made in the best interest of the child.

Addressing Concerns and Controversies

The decision to open new gender clinics with stricter referral criteria has sparked debate among healthcare professionals, advocacy groups, and the public. While many have welcomed the move as a positive step towards safer and more effective care, others have raised concerns about the potential for increased barriers to accessing treatment and the implications for children’s rights.

Balancing Access and Safety

One of the primary concerns raised by critics is the potential for the stricter referral criteria to create additional barriers to accessing care. There is a fear that some children who genuinely need medical interventions may be denied treatment or face lengthy delays due to the more rigorous assessment process.

However, the NHS has emphasized that the goal of the new criteria is not to restrict access to care but to ensure that all decisions are made based on the best available evidence and in the best interest of the child. By prioritizing psychological support and careful assessment, the NHS believes it can provide a safer and more effective model of care that reduces the risk of harm.

The Role of Informed Consent

Informed consent is a cornerstone of the new referral process, but it has also been a source of controversy. Some critics argue that children, particularly those under the age of 16, may not have the capacity to fully understand the long-term implications of medical interventions and therefore cannot provide true informed consent.

In response, the NHS has implemented a comprehensive consent process that includes detailed discussions with both the child and their parents or guardians. This process is designed to ensure that all parties fully understand the potential risks and benefits of treatment and that decisions are made collaboratively.

The Importance of Research and Evidence

Another point of contention is the lack of high-quality research on the long-term outcomes of medical interventions for gender dysphoria in children. While the Cass Review highlighted this as a significant concern, some advocacy groups argue that the focus on research should not come at the expense of providing timely and appropriate care to those in need.

The NHS has committed to promoting research and evidence-based practice as part of the new model of care. By investing in high-quality studies and long-term follow-up, the NHS aims to build a stronger evidence base that can guide clinical decision-making and improve outcomes for young people with gender dysphoria.

The Road

Ahead: What the Future Holds

As England moves towards the establishment of these six new gender clinics, the healthcare landscape for children with gender dysphoria is set to undergo significant changes. The new model of care, with its emphasis on psychological support, comprehensive assessments, and stricter referral criteria, represents a shift towards a more cautious and evidence-based approach to treatment.

Implications for Children and Families

For children and families navigating the challenges of gender dysphoria, the new clinics offer the promise of more accessible and consistent care. The regional approach will reduce waiting times and ensure that children across England can receive the support they need closer to home. The focus on psychological support as the first line of care also provides a more holistic approach to addressing the complexities of gender dysphoria.

However, the stricter referral criteria may also mean that some families face more hurdles in accessing medical interventions. While this may be seen as a necessary safeguard, it is important that the NHS provides clear communication and support to help families understand the new process and make informed decisions.

The Role of Healthcare Professionals

For healthcare professionals, the new clinics will require a shift in practice towards a more multidisciplinary and collaborative approach to care. The emphasis on comprehensive assessments and the involvement of a wider range of specialists will necessitate ongoing training and education to ensure that all staff are equipped to provide the highest standard of care.

Additionally, the focus on research and evidence-based practice will require healthcare professionals to stay informed about the latest developments in the field and to contribute to the growing body of knowledge on gender dysphoria in children.

Ongoing Monitoring and Evaluation

As the new clinics are established and the stricter referral criteria come into effect, it will be essential to closely monitor and evaluate the impact of these changes. The NHS has committed to ongoing review and refinement of the model of care, with a focus on ensuring that it meets the needs of children and families while maintaining the highest standards of safety and effectiveness.

Regular audits, feedback from patients and families, and continued research will be key components of this monitoring process. By remaining responsive to the needs of those it serves, the NHS can ensure that the new clinics fulfill their goal of providing a “fundamentally different and safer model of care.”

Conclusion

The decision to open six new gender clinics for children in England by 2026 represents a significant step forward in addressing the growing demand for gender identity services. The new model of care, with its emphasis on psychological support, comprehensive assessments, and stricter referral criteria, is designed to provide a safer and more effective approach to treating gender dysphoria in young people.

While the changes have sparked debate and raised concerns about access to care, the NHS believes that the new clinics will offer a more consistent and evidence-based approach that prioritizes the well-being of children. As these clinics are established and the new referral criteria come into effect, it will be essential to continue monitoring and evaluating the impact of these changes to ensure that they achieve their intended goals.

Ultimately, the success of this new model of care will depend on the collaboration and commitment of healthcare professionals, researchers, and the wider community to provide the highest standard of care to children experiencing gender dysphoria. By working together, it is hoped that these new clinics will provide a safer, more supportive environment where young people can explore their gender identity and receive the care they need to thrive.