Update: March 2021

On Friday 26 March 2021 the High Court handed down a judgment that confirms parents can consent on behalf of their child for hormone treatment to suppress puberty. Read the judgment on the Judiciary.uk website.

The judgment relates to a private court application brought by the parents of a child with gender dysphoria. The parents asked the court to clarify whether parents can consent to treatment with puberty blockers, in light of the decision in Bell.  The Trust was joined as a respondent in those proceedings.

The Court decided that parents are legally able to consent on behalf of their child to treatment to suppress puberty. It noted that parents are, in general, in a position to understand and weigh up these matters and consider what is in the long- and short-term best interests of their child. As adults with full capacity and as the people who know their child best, and care for them most, they will be in a position to reach a fully informed decision. The Court also decided that treatment to suppress puberty does not fall within a “special category” of treatment which generally requires court authorisation in advance.  Today’s judgment does not change the Bell judgment in respect of the ability of under-16s to consent for themselves.

The Trust welcomes the judgment We are liaising with NHS England to consider how this ruling may impact on our practice.

Update: January 2021

Permission granted to appeal High Court judgment on consent for puberty-blocking treatment

The Tavistock and Portman NHS Trust, which leads the national Gender Identity and Development Service (GIDS), has today (Monday 18 January) been granted permission by the court to appeal against the ruling, alongside University College Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust, whose paediatric endocrinologists prescribe and administer puberty-blocking drugs on behalf of GIDS. 

Read more about the appeal.

Information following the Judicial Review judgment, updated January 2021

The Trust was disappointed by the judgment on 1 December 2020 (read the full judgment on the judiciary.uk website) and we understand that the outcome was unsettling news for patients and their families. Our first duty is to our patients, particularly those currently receiving hormone blocking treatment and we are working with our partners, University College London Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust, to provide support for patients concerned about the impact on their care.

For existing patients please be reassured: there are no immediate plans to stop your treatment with puberty blockers or cross sex hormones.

The Court ruled that there will be a stay on implementation of its judgment until the determination of the appeal we have lodged. In January 2021 the Trust, together with University College London Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust, had permission to appeal granted.

This will give us a chance to work through the specific implications of the judgment for different patient groups with our partners, University College London Hospitals NHS Foundation Trust and Leeds Teaching Hospitals Trust. We will not be making new referrals to endocrinology until we have more clarity and future referrals will require a court order for under-16s.

The Trust confirms its ongoing support for the review commissioned by NHS England being led by Dr Hilary Cass.

We understand that our patients and their families are likely to have lots of questions in the wake of this judgment. Below we have prepared a Q&A which will attempt to address some of the key questions we expect you may have. We will update these answers as soon as we know more, and recommend that if you have further questions, to check this page in the coming days for further updates.

Please note the ruling does not affect those over 18.

Contact information for patients, parents/guardians, and patients on our waiting list

If you are a patient or parent/guardian of a patient on our waiting list and have a query you can use the below contact details:

We will answer as many calls as we can, but ask that you please email in the first instance if you can.

Should you or a young person need urgent medical attention, we strongly suggest that you get in touch with your local Child and Adolescent Mental Health or emergency services, who will be best placed to respond.

If you are a member of the press, please email communications@tavi-port.nhs.uk.

Answers to common questions following the judgment

What will happen to my treatment?

Read or download a letter that has been sent following the judgment to those service users who are currently in endocrine treatment.

We would like to reassure those already in treatment in our endocrinology clinics at Leeds Teaching Hospitals NHS Trust and University College London Hospitals NHS Foundation Trust that there will be no interruption to your treatment. We are  putting in place a new system for accessing physical interventions. All those who were in treatment or had consented to referral to our endocrinology service prior to 1 December 2020 have been contacted to explain how this process will work.

The University College London Hospitals / Leeds Teaching Hospitals teams and the Gender Identity Development Service at the Tavistock and Portman have started conducting clinical reviews for these cases, working with young people and their parents/carers to make sure they fully understand the treatment. Patients will be contacted directly to arrange theirs in due course.

The purpose of the clinical review is for us to decide, together with patients, whether a continuation of treatment, either with Gonadotropin-releasing hormone agonist (GnRHa) or gender affirming hormones) is in their “best interests”. If that is what we conclude, and if patients and carers agree with that conclusion, we will apply to the Court to obtain best interests assessments about the continuation of treatment.

It is expected that GPs will continue to prescribe to this cohort. In cases where this does not happen, please let your endocrinology service know and they will advise.

A recent judgment (March 26, 2021) has ruled that parents are able to consent on behalf of their child for hormone treatment to suppress puberty. We are working with our commissioners to understand the impact of this judgment and we will provide further updates in due course.

If you have any questions about this, please contact us directly.

How does GIDS support young people and their families?

It is important to remember that GIDS is, and has always been, primarily a psycho-social service providing extensive support to children and young people facing issues pertaining to the development of their gender identity. This psycho-social support provided to children and young people will remain of the upmost importance, even more so in times of uncertainty. Our focus remains to support patients in the best way we can.

We offer a safe and supportive environment for children and young people to explore issues relating to their gender identity and wider development. Even before this judgment, only a minority of those referred to the service progressed on to a physical intervention pathway. We are confident that GIDS can continue to be a source of great support to you. Where appropriate, we may also liaise with local services and support you in getting any additional help you may need.

Have you stopped making new referrals to endocrinology services? Will new referrals happen in future?

Due to the direction of the Court in the Bell judgment and the need to prioritise our existing endocrinology patients in seeking best interests assessments, for the time being, we have decided not to make any new referrals to endocrinology. Now that the clinical reviews of cases have started, we will consider at what point we are able to include patients who have completed their assessment in this process with a view to a referral to endocrinology.

I am currently on puberty blockers. What happens next?

The University College London Hospitals / Leeds Teaching Hospitals teams and the Gender Identity Development Service at the Tavistock and Portman will conduct clinical reviews of current endocrinology cases, working with you and your parents/carers to make sure you all fully understand the treatment. These clinical reviews have started and you will be contacted directly to arrange yours in due course.

The purpose of the clinical review is for us to decide, together with you, whether a continuation of puberty blockers is in your “best interests”. If that is what we conclude, and if you agree, we will apply to the Court to obtain best interests assessments about the continuation of treatment. You should have received a letter letting you know you will continue to receive your medication until the outcome of this application to the Court is known. 

It is expected that GPs will continue to prescribe your medication. In cases where this does not happen, please let your endocrinology service know and they will advise. Alternatively, if you do not want to continue with puberty blockers, or if we decide through our clinical review with you that it is not in your best interest to continue with puberty blockers, we will agree a timeframe for withdrawing medication in a clinically safe way. 

A recent judgment (March 26, 2021) has ruled that parents are able to give valid consent on behalf of their child for hormone treatment to suppress puberty. We are working with our commissioners to understand the impact of this judgment and will provide further updates in due course.

I am currently on gender-affirming hormones. What happens next?

The Court recognised that the legal position for 16 or 17 years is different. Therefore, a Court order may not be necessary for you to continue to receive puberty blockers or cross sex hormones.

We will still carry out a clinical review of your case, working with you and your parents/carers to make sure that you all fully understand the treatment. If there is any doubt between us about what is in your best interests, we will consider an application to the Court for a best interests order. Again, your medication will continue until the outcome of this application to the Court is known.

I am currently on puberty blockers from a private provider. What happens next?

This judgment applies to the treatment, not to the provider. This means that all providers, public and private, are bound by it. This includes puberty blocking medication administered in England and Wales.

If my puberty blockers from GIDS are stopped, can I access them via private providers?

You should have received a letter letting you know you will continue to receive your medication until the outcome of this application to the Court is known. 

It is expected that GPs will continue to prescribe your medication. In cases where this does not happen, please let your endocrinology service know and they will advise.

I am on puberty blockers and have been discussing accessing gender-affirming hormones with my clinicians. Will those still be available to me?

The Court recognised that the legal position for 16 or 17 years is different. Therefore, a Court order may not be necessary for you to continue to receive puberty blockers or cross sex hormones.

We will still carry out a clinical review of your case, working with you and your parents/carers to make sure that you all fully understand the treatment. If there is any doubt between us about what is in your best interests, we will consider an application to the Court for a best interests order. Again, your medication will continue until the outcome of this application to the Court is known.

GIDS will provide psycho-social support throughout this process and beyond and you will not be discharged from the service unless you wish to be. We will keep updating the information on this page as we know more.

I am completing my assessment at GIDS and we have discussed a referral to the endocrinology team. What happens next?

We needed to pause new referrals to endocrinology while we worked through the specific implications of the judgment for those already in treatment or who had already consented to referral to endocrinology before the judgment. We designed the clinical review process which now needs to happen before such a referral can be made.  Clinical reviews have now started. We will now consider at what point we are able to include patients who have completed their assessment in this process. We will update this information as soon as we know more, so do check back periodically. You will also receive a letter as soon as we are able to offer you a clinical review of your case. Your psycho-social clinicians are here to support you through this period.

While referrals to the endocrinology team may be paused for the time being, it does not mean that you will be discharged from GIDS, or that you will not be able to access physical treatment via GIDS.

I am 16 or 17. What does the judicial review judgment mean for me?

As the High Court confirmed and as is reflected in NHS England's revised specification there is a presumption that 16- and 17-year-olds have the ability to consent to medical treatment. However, the judgment also highlighted that clinicians might want to seek authorisation from a court if there is doubt about someone’s ability to consent. In light of this, and to continue supporting our patients, we are taking the step of reviewing each current 16 and 17 year-old patient’s needs, to assess whether the treatment they are on continues to be recommended. In circumstances where capacity is in doubt, and/or where there is any uncertainty as to what is in the patient’s best interests, the lead clinician will need to consider an application to Court to determine those issues.

I am a GP. Should I continue to prescribe puberty blockers and cross-sex hormones?

Access to medication should not be withdrawn. The University College London Hospitals / Leeds Teaching Hospitals teams and the Gender Identity Development Service at the Tavistock and Portman will conduct clinical reviews of current endocrinology cases, working with young people and their parents/carers to make sure they fully understand the treatment. These clinical reviews have started and patients will be contacted directly to arrange theirs when their turn comes.

The purpose of the clinical review is for us to decide, together with patients, whether a continuation of physical treatment is in their “best interests”. If that is what we conclude, and if patients and carers agree with that conclusion, we will apply to the Court to obtain best interests assessments. We have let patients know that they will continue to receive their medication until the outcome of this application to the Court is known.  It is expected that GPs will continue to prescribe to this cohort. If you have any questions about this, please contact the referring endocrinology clinic directly.

A recent judgment (March 26, 2021) has ruled that parents can consent on behalf of their child for hormone treatment to suppress puberty. We are working with our commissioners to understand the impact of this judgment and will provide further updates in due course.  

 

When do these new rules start?

The judgment and new specifications do not stipulate that any existing treatment must be automatically stopped. The Court has ruled that there will be a stay on implementation of its judgment until the determination of the appeal we have lodged.

As well as seeking to overturn this judgment, we are preparing for its implementation to ensure that treatment need not be interrupted for existing patients and we can start once again referring patients to our endocrinology clinics.

GIDS will provide psycho-social support throughout this process and beyond.

My child has become distressed as a result of the judgment. Where can they and I access support?

If you are a patient or parent/guardian of a patient on our waiting list and have a query you can use the below contact details:

We will answer as many calls as we can but ask that you please email in the first instance if possible.

If you are currently being supported by your GP, a Children and Young People’s Mental Health Service, a paediatric or medical team or Children’s Social Care, then talk to them about your feelings and worries. It may help to show them this letter. These professionals are also very welcome to contact either our team or the Tavistock for further advice in how best they can help you

Otherwise, we recommend discussing any concerns your child has at their next scheduled GIDS appointment.

We need help now! Who can I contact?

Your local mental health services will have a 24/7 crisis line that you can call.

Search for the name of your local area AND CAMHS mental health crisis number and your local number should come up.

The NHS is here to support you and your family. If you want to talk to someone, help is here for you:

If you need urgent mental health support or advice, please head to: https://nhs.uk/urgentmentalhealth

This website can tell you which NHS organisations can help you in your area, including 24/7 crisis support, or you can text SHOUT to 85258

If you are currently being supported by your GP, a Children and Young People’s Mental Health Service, a paediatric or medical team or Children’s Social Care, then talk to them about your feelings and worries. These professionals are also very welcome to contact either our team or the Tavistock for further advice in how best they can help you.

You may also wish to access support from local trans groups and charities.

Who can I speak to for more information?

This web page is where we will keep up to date information with regards to the impact of the judicial review judgment on the care we are able to provide. Do check back in periodically for updates. You may also wish to speak to charitable groups in your local area. You can find a list of them here https://gids.nhs.uk/talking-other-people