NHS child gender clinic: Staff welfare concerns ‘shut down’ – BBC Newsnight

published on July 9, 2020

Young people struggling with theirgender identity may be referred toEngland's only specialist clinic thegender identity development service orJade's based at London's Tavistockcomportment foundation trust it's adifficult area to work in and last year

Following serious staff concerns overchildren's welfare the trust conductedan internal review of the service itrecommended areas for improvement butdid not identify any immediate issues inrelation to patient safety yet evidence

Exclusively seen by Newsnight revealsserious tensions at the heart of Jed'swe've seen well over a hundred pages oftranscripts of interviews conducted withstaff as part of the review they make aseries of claims staff say they were

Discouraged from going to the leadsafeguarding officer with concerns aboutchildren's welfare they say decisionsabout medical treatment were taken tooquickly and they say that some parentsappear to prefer their childhoods

Transgender and straight rather than gaypushing them towards transition thetranscripts have been voiced in thisfilm by actors and edited for claritybut the words were all relatedclinicians to the Trust's medical

Director as part of the review processlet's pray that I am wrong because if Iam NOT wrong very many vulnerablechildren have been very poorly treatedand we'll be left with potentially alifetime of damage here we're not

Talking about little things the realityis by not doing anythingchildren are potentially still beingmedically mismanaged when a child isassessed by Jed's they may be offered adrug called a puberty blocker these stop

A young person's body developing breastsperiods facial hair or a deeper voicethe NHS has recently updated itsguidance on these drugs acknowledgingthat little is known abouttheir long-term effects or what impact

They might have on children's brains andbonesJude's has said in the past it findsitself caught between people who wantthese treatments to be given quickly andthose who think they shouldn't be given

At allmany children refer to jets areextremely distressed and have complexneeds the clinicians we've spoken to saythere's often lots to explore beforemedication should be considered but they

Say there's wide variation in practiceit's claimed in the transcripts thatmany staff are worried and openlydiscussed their fears maybe we aremedicating gay kids maybe weremedicating kids with autism maybe we are

Medicating traumatized children and ifwe are we're doing bad things to thesevulnerable kidsNHS England says that young peopleshould be referred for medical treatmentpuberty blocking drugs after a minimum

Of three sessions put the roof you heardfrom several staff that one member ofthe Jude's leadership Sarah Davidsonwould refer children for treatment afteronly one or two appointments I wasworking with an executive on one case of

Assessment of a young person and theexecutive member agrees to refer thisperson to the medical pathway within thefirst hour of meeting him and that isnot supposed to happen absolutely itshould never happen because this is a

Pathway that will lead to huge hugechanges for this young person you knowit could lead to potentially infertilityand so on we've been told that caseslike this have been discussed at teammeetings and jed's when some staff

Raised concerns about the speed ofassessment we understand the responsewas typically that the young person wasexperiencing very intense and severegender dysphoria such a quick referralwouldn't allow for full exploration of

What else is going on staff claim theysay this could risk putting young peopleon potentially life-changing medicineswho may have been struggling with issuessuch as their mental health andsexuality

Homophobia in families is mentioned inall of the transcripts Newsnight Essenestaffs say that while there was somediscussion in the service about thisthey didn't feel the issue was properlyaddressed we've spoken to a number of

Staff off the record most didn't want togo on camera even on the condition ofanonymity but the transcripts are backedup by this former clinician who leftkids last year their words are beingvoiced by an actor we didn't have a lot

Of families and parents who wouldactively tell us that oh I'm so glad atleast my child is not gay or lesbianimplying that having a trans outcomewould be better for their children I hada case there was a lot of trauma in the

Family the young person had come outinitially as a lesbian and had faced alot of homophobic bullying both verysubtly within the family and quiteopenly in school and suddenly the youngperson changed their mind and they

Started identifying as trans in some ofthese cases clinicians thought that itwouldn't be appropriate for them torefer for puberty blockersbut they will be overruled by Jude'sdirector Polly Carmichael the transcript

Suggests the young person had veryclearly told me and my colleague that mymum wants the hormone more than I do andwhen we took it to senior managementPolly Carmichael she suggested that werefer even though this was not

Clinically indicatedthese are only some of the examplesmentioned in the transcripts staff alsovoiced concerns about the degree oftrauma they're witnessing in childrenand the process of gaining consent for

Medical treatment it's accepted in thereview that staff raised these concernsover a number of years both to theleadership of Jed's and to seniorfigures in the Tavistock trust but inthe transcripts staff say they won't

Listen to the reality is that ourconcerns were raised all the time andwas shut down and that when they didspeak upthey were then seen as the problempeople who raise concerns are seen as

Troublemaking and difficult I think itis the case that somehow theorganization works to evacuate peoplewho are not compliant when I raisedconcerns I was told that I had to toethe line or I would never progress in my

Career staff also say that seniormanagement were not able to reassurethem that their concerns were unfoundedI kept saying to her are we hurtingchildren and she did not say no I keptsaying to it well we get sued she did

Not say no the only solace she gave mewas that she said it would not be methat would be sued it would be theTavistock that would be sued she was notable to say to me it's fine we are nothurting the children in the transcripts

We've seen clinicians are worried aboutthe impact different kinds of abusemight have on young people trying toresolve questions about their genderidentity these could be seen assafeguarding issues

Staff claimed they would discourage fromreferring these cases to social servicesand from seeking advice the Tavistocklike other NHS organisations has a namedperson clinicians can turn to to discussspecific safety concerns that person is

Sonia Apple B but the transcripts allegethat staff were discouraged fromspeaking to her by the director ofJade's Polly Carmichael there was a veryclear message from senior managementabout being really cautious about how we

Talk to the safeguarding team at theTavi and specifically Sonia Appleby Iknow that Polly feels she does not likeSonya's scrutiny I think that is odd sheis the trust safeguarding lead I've hadsome consultations with Polly Carmichael

About some of the young people I wasseeing and some of the concerns I'draised and Polly very directly told menot to go to Sonia to share thoseconcerns is that safe no and I would saythe perhaps that's why more than 40

Clinicians decided to leave the servicewithin three years we've been told thatif clinicians did approach Sonia Applebythey felt she understood the complexityof the Jude's work and was supported byher mrs Applebee solicitor told us that

She'd started legal proceedings againstthe trust last year and it wouldn't beappropriate to comment further it'sunlikely that all staff will have beenas critical of Jade's as the ones whoseinterviews we've read but the

Transcripts we've seen represent asizable minority of the total conductedwith frontline Jade's staff the reviewacknowledged the need to address andwarranted variation at Jade's andaccepted the need to be more robust in

Resolving concerns raised by staff italso recommended new regular audits ofsafeguarding practices and socialservices referrals but some staff don'tfeel it went far enough and are notconfident in the current management's

Ability to enact change Newsnight hasseenevidence that the Tavistock chiefexecutive and chair have been told thatthe interview transcripts may containconcerns about child protection issues

And they've been encouraged to read themthemselves we showed some of thetranscripts to the Children'sCommissioner for England and contactedthe healthcare regulator at the CQCabout what we'd seen both were

Interested in speaking to the peopleinvolved the CQC encouraged anyone withspecific safeguarding or safety concernsto contact them directly it added thatit is due to inspect kids though becauseof kovat routine inspections are

Currently paused until autumn anofficial NHS review is underway into howyoung people visiting Jed's should bebest supported there is good practicetaking place at the surface but for somestaff this review cannot be completed

Soon enough Deborah Cornwell no one fromthe Tavistock and Portman NHS FoundationTrust agreed to be interviewed on theprogramme but in a statement the Trustsaid Jude's is a safe and caring servicewhich supports a wide range of children

And young people grappling with distressabout their gender identity theTavistock and portland NHS foundationtrust stands by 2019 review of theservice we are confident that it fairlyaddressed the issues raised and strongly

Refute the allegations put to us byNewsnight safeguarding is of the utmostimportant to the trust in August 2018 asafeguarding lead was createdspecifically for Jed's to reflect thegrowth in the service this role fits

Within the well understood safeguardingpathway and procedures across the trustwell the trust said that anysafeguarding issues that were identifiedduring the review where fatherinvestigated and where appropriate

Addressed in the reviews recommendationsand that they have kept both NHS Englandand the Care Quality Commission dulyinformed the trust added that themajority of patients using the servicewill not be referred to an endocrinology

Service for considerationfor hormone-blocking drugs well detailsof organizations offering informationand support but some of the issuesraised in that film are available at BBCdark kudoh

UK or you can call for free at any timeto hear recorded information on Oh 8hundred o 77077

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