The most senior doctor at The Tavistock controversial child gender clinic has insisted that it provided "appropriate" care for patients and suggested it does not need to change.

The Gender Identity Development Service (Gids) is being shut down by the NHS after an independent review found it is "not safe" for children, to be replaced with two new regional hubs.

But Prof Gary Butler, clinical lead for the clinic at The Tavistock and Portman NHS Trust, the only hub for transgender-identifying children in England and Wales, has now appeared to criticise the author of that review, Dr Hillary Cass, for "nepotism". 

Dr Cass, a highly experienced paediatrician, called for a "fundamentally different" model of care in her report, but did not select any hospitals or put forward any suggestions.

In a speech to hundreds of transgender healthcare clinicians at a conference in Ireland, Prof Butler, who has been given a leading role in reforming Gids, allegedly described Dr Cass's recommendations as "slightly unusual", and pointed out that she stressed the need to provide "developmentally appropriate healthcare for children and young people".

He then added: "But what on earth are we doing now? It's exactly what we're doing at the present time, and what the Gids is doing."

The comments emerged in a recording obtained by BBC Newsnight of the speech at the European Professional Association for Transgender Health conference.

According to the programme, Prof Butler, consultant paediatric endocrinologist at University College London Hospitals (UCLH), also appeared to accuse Dr Cass of "nepotism" by implying that her previous involvement in two hospitals in the south of England had been a factor in them being chosen to lead the new service.

The final closure of Gids has now been delayed until at least March 2024, though 8,000 young people remain on the soaring waiting list.

NHS England told The Telegraph that officials were working to extend the clinical team to include experts in paediatric medicine, autism, neurodisability and mental health, as well as restricting access to hormone blockers to the context of a formal research protocol, and "all aspects… will be guided" by the Cass Review.

Irreversible drugs

It comes after long-running concerns that The Tavistock prescribed drugs, some of them irreversible, too quickly without fully assessing whether a child's trans identity was in fact a front for bullying or mental health problems.

At UCLH, Prof Butler's role includes prescribing medication such as puberty blockers and hormones to youngsters deemed suitable for them by Gids.

Em, a 19-year-old trans man, who was born female but has identified as male since childhood, told Newsnight that he was offered medication during his second appointment aged 11.

He claimed that after five appointments, Gids referred him to UCLH for puberty blockers, which he says Prof Butler prescribed him aged 12 and he continued taking them for four years.

"They push the drugs on you so early on," he told the programme, adding that having collapsed at school and suffered severe mood swings and weight gain while on the blockers, he now "feels completely forgotten about" since stopping taking them.

Prof Butler said: “Some of the comments reported from my presentation are highly selective and I wish to make clear that I fully support Dr Hilary Cass’s recommendations to develop new services for young people experiencing gender dysphoria."

A UCLH spokesman said: “It would be inappropriate to comment on an individual patient’s care but Gids clinicians discuss non-medical interventions with patients before and after referral to our endocrinology clinic.

The spokesman added that "patients only begin medical treatment if they are assessed as having full competence to consent and there is parental support" and inspectors had found their patients were supported to make "informed decisions" about treatment.

The Cass Review team said there was "a general consensus that the current model of care, within a single specialist gender service, cannot provide timely, holistic care for the mix of children and young people seeking support around their gender identity" and its review was driven entirely by "emerging evidence, good clinical practice and the best interests of the children, young people and their families".

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2023-05-24T16:52:00Z dg43tfdfdgfd