Statement in response to the January 2021 CQC report on GIDS

In 2016 the CQC rated our Gender Identity Development Service as Good, but following its inspection in October, it has now rated the service ‘inadequate’.

A spokesperson said: “We take the CQC’s report very seriously and would like to say sorry to patients for the length of time they are waiting to be seen, which was a critical factor in arriving at this rating. We know the difficulty this wait is causing them and their families and we agree with the CQC that the growth in referrals has exceeded the capacity of the service.

We very much accept the need for improvements in our assessments, systems and processes. In addition, we have submitted our plan to improve the management of our waiting list to the CQC and are working with our commissioners, NHS England, and others to improve access to the service. We are determined to get this right for children and young people and will be agreeing a full action plan with the CQC to address further concerns.

We are already finalising plans to bring in senior clinical and operational expertise from outside the service to help us implement the necessary changes and consider how we can improve on current processes and practice – including how we standardise our assessment process.

We will continue to support Dr Hilary Cass who has been commissioned by NHS England to make recommendations on the care provided to children and young people questioning their gender identity or experiencing gender incongruence.

Above all, we remain focused on providing a high quality service to children and young people in our care and supporting our staff who, despite the challenging context they have been working in, have been praised by the CQC for their understanding, compassion and kindness. Patient feedback was reported as overwhelmingly positive and we will involve both patient and staff as we build on these strengths.

The GIDS endocrinology services at UCLH and Leeds Children's Hospital, which prescribe any medication to young people, were also reviewed. The findings at both were positive, the CQC noting that they “supported young people and their families to make informed decisions” and “had a good understanding of Gillick Competence and applied this proportionately when obtaining consent from young people.”

The Tavistock and Portman NHS Foundation Trust is committed to providing high quality care to patients and its overall rating remains ‘good’.”

Video message from Paul Jenkins, CEO, to the young people and families supported by GIDS

Watch on Youtube.

An open letter from the CEO of the Tavistock and Portman NHS Foundation Trust

In recent times, the Gender Identity Development Service has found itself in the middle of a cultural and political battleground. This followed a rapid rise in referrals which has been hard to manage, both in terms of the numbers but also the wide range and often complex needs of patients seeking support.

The Care Quality Commission (CQC), our regulator, rated GIDS as good in 2016, but following an inspection last October has today rated the service as ‘inadequate’.

I entirely accept we have struggled to manage our waiting lists and agree with the CQC’s assessment that the growth in referrals has exceeded our capacity. As a result, vulnerable young people and their families have not had adequate access to the care they expect and deserve. I would like to apologise for falling short in our support of young people and families. I know from my own inbox just how challenging these long waits are, particularly in the current climate.

We also recognise the importance of making our decision-making process more systematic, consistent and transparent, particularly in relation to assessments and improving record-keeping.  The Trust carried out an internal review of the service and published an action plan in March 2019. We’ve made significant progress in implementing the recommendations of this plan, but we know we have a lot further to go. We will be addressing this in the action plan we are producing for the CQC in response to the requirements they have set us.

We are already making plans to bring in independent clinical and operational expertise to work with our staff to build on the changes we’ve made.

Embedding these improvements will be a significant undertaking for our staff and I personally pledge to support them through this period. GIDS is recognised by the CQC as a caring and dedicated group of NHS professionals I am proud of their skill and dedication. Patient feedback was reported as overwhelmingly positive and we will involve both patient and staff as we build on these strengths as we move forward.

We will also continue to support Dr Hilary Cass who has been commissioned by NHS England to make recommendations on the care provided to children and young people questioning their gender identity or experiencing gender incongruence.

I will continue to keep everyone updated with the progress we make. I want to reassure you we will continue to listen and work with everyone to answer questions as honestly and as quickly as we can.

You can read the full report on the CQC website.

Best wishes,

Paul Jenkins, Chief Executive, The Tavistock and Portman NHS Foundation Trust