Source · HSSIB Patient Safety Investigation
Provision of care for children and young people when accessing specialist gender dysphoria services
Published 6 April 2022
Launched 11 May 2021
Published
HSIB Legacy
Access to care
This investigation explores the care of patients who present to child and adolescent mental health services (CAMHS) with questions about their gender identity and are referred to specialist gender dysphoria services.
Summary
1 recommendation
4 observations
1 of 1 responded
Safety Recommendations
R/2022/191
NHS England
HSIB recommends that NHS England and NHS Improvement incorporates the findings of this investigation into plans to further review and develop the service specifications for specialised gender dysphoria services. This should include further work with relevant stakeholders to: A Identify the role of relevant voluntary and charitable sector organisations in supporting patients with gender identity concerns and facilitate information sharing between these organisations and regional professional support services. B Identify work to improve the transfer of care, management, and proactive risk assessment of patients who are moving from the Gender Identity Development Service waiting list to a gender dysphoria clinic waiting list.
NHS England and NHS Improvement are establishing new regional gender identity services by 2023/24, which will inform new service specifications. A consistent transfer protocol for young people moving from GIDS to adult GDCs will be adopted by December 2022.
Response received 4 July 2022
We have put in place a significant programme of work to address long waiting times to the Gender Identity Development Service (GIDS), the main causes of which are increasing demand and the limited clinical workforce potential to meet that demand. We have commissioned an independent external review of gender identity services for children and young people under the chairmanship of Dr Hilary Cass OBE, a former President of the Royal College of Paediatrics and Child Health. The terms of reference for the review are broad, including: the future clinical model; the relationship across the various services that may care for children and young people with gender dysphoria; and future clinical workforce and training needs. The Cass Review has recently recommended that alternative regional centres should be developed, as soon as possible. We are now working with the Cass Review to establish these new centres as soon as feasibly possible, with a view to consulting on a new service specification later this year. In order to address the inconsistent protocols that have emerged across the seven NHS-commissioned Gender Dysphoria Clinics (GDC) for adults (describing the process for the transfer of young people from the waiting list for GIDS to the waiting list of a GDC), a clinically-led working group is developing a single consistent transfer protocol which will be tested with the GDCs over the next few months ahead of adoption during 2022/23. Actions planned to deliver safety recommendation: Establish new regional services that will assess, diagnose and provide care by 2023/2024 through the dedicated work programme within the Specialised Commissioning Directorate. Other dependencies: Work with Cass Review to define new clinical model. Additional comments: Work to build a new service specification will identify the role of relevant voluntary and charitable sector organisations in supporting patients with gender identity concerns and facilitate information sharing between these organisations and regional services. Adopt a consistent protocol across adult GDCs and GIDS governing the transfer of young people from the GIDS waiting list to GDCs by December 2022 through the clinical working groups established, comprising clinicians from GDCs and GIDS. Response received on 4 July 2022.
Safety Observations
Observation 1
Observation
It may be beneficial if professional bodies produced further advice and guidance to assist NHS staff who may need to provide care to patients with gender identity concerns while patients are waiting to access support from specialised gender dysphoria services.
Observation 2
Observation
It may be beneficial if local healthcare commissioners had up-to-date and easily accessible resources to identify all relevant services within a locality that could provide support to patients with gender identity concerns.
Observation 3
Observation
It may be beneficial if further work considered the ability to allow for shared record systems and ways to appropriately share information between NHS and non-NHS services involved in the care of patients with gender identity concerns.
Observation 4
Observation
It may be beneficial if further work considered the availability and accessibility of specialist training to help in the care of children and young people who have gender identity concerns or gender dysphoria.