Children will no longer be prescribed puberty blockers after landmark NHS ruling

12 March 2024, 16:27 | Updated: 15 March 2024, 10:09

Tavistock Centre (l) and Dr Hilary Cass (r)
Tavistock Centre (l) and Dr Hilary Cass (r). Picture: alamy

By StephenRigley

Children will no longer be prescribed puberty blockers at gender identity clinics, a landmark NHS ruling has confirmed.

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Puberty blockers, which pause the physical changes of puberty such as breast development or facial hair, will now only be available to children as part of clinical research trials.

The Government said it welcomed the decision, adding it would help ensure care is based on evidence and is in the "best interests of the child".

The ruling follows a public consultation on the issue and an interim policy, and comes after NHS England commissioned an independent review in 2020 of gender identity services for children under 18.

The Tavistock Clinic
The Tavistock Clinic. Picture: Alamy

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The review, led by Dr Hilary Cass, followed a sharp rise in referrals to the Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust, which is closing at the end of March.

In 2021/22, there were over 5,000 referrals to Gids, compared to just under 250 a decade earlier.

The clinic has come under repeated scrutiny.

In February 2022, Dr Cass published an interim report saying there was a need to move away from one unit and recommended the creation of regional services to better support youngsters.

She also pointed to a lack of long-term evidence and data collection on what happens to children and young people who are prescribed medication.

She added that Gids had not collected routine and consistent data "which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service."

Following the closure of the Tavistock's Gids clinic, two new NHS services will now open in early April, situated in London's Great Ormond Street Hospital and Alder Hey Children's Hospital in Liverpool.

The NHS has said children attending these clinics will be supported by clinical experts in neurodiversity, paediatrics and mental health, "resulting in a holistic approach to care".

Health minister, Maria Caulfield, said: "We have always been clear that children's safety and wellbeing is paramount, so we welcome this landmark decision by the NHS.

"Ending the routine prescription of puberty blockers will help ensure that care is based on evidence, expert clinical opinion and is in the best interests of the child."

The consultation on the future of services received more than 4,000 responses, including around a quarter from members of the public, 22 per cent from patients, 21 per cent from parents, 10 per cent from trans adults and five per cent from clinicians.

John Stewart, national director of specialised commissioning at NHS England, said: "Given that the debate is often very polarised, so too were the responses to the consultation.

"Many people said the policy didn't go far enough in terms of still allowing potential access (to puberty blockers) through research, and others saying clearly they disagreed fundamentally and that these should be routinely available to everyone who believes they need it."

Regarding the new clinics, he said: "This is just the first step in building a regional model, where our aim is to establish between seven and eight specialist centres including the north and the south hubs over the next year to two years."

Around 250 patients are expected to be transferred to the new clinics from Gids when they open.

Some 5,000 more children and young people are currently on the waiting list for referral into the new clinics.

Mr Stewart said: "Our two new providers on their own are not going to be able to make a significant dent immediately in that waiting list, but what they are doing is helping us establish a new and fundamentally different service model, in line with advice from the Cass review."

He said other regional centres could hopefully be commissioned quickly "and once we get to that point we should begin to see significant movement in that waiting list and numbers falling.

"The speed and pace at which the clinics will be able to see new patients off the waiting list is in large part going to be dependent on how successful their ongoing recruitment into the service is, and that is not straightforward."

Fewer than 100 young people are currently on puberty blockers.

They will be able to continue their treatment and are being seen by specialist endocrine services at Leeds and University College London Hospital.

It is understood NHS England hopes to have a study into the use of puberty blockers in place by December 2024, with eligibility criteria yet to be decided.

In 2021/22, there were over 5,000 referrals to Gids, compared to just under 250 a decade earlier.

Former PM Liz Truss said: “I welcome NHS England’s decision to end the routine prescription of puberty blockers to children for gender dysphoria.

“I urge the Government to back my Bill on Friday which will reinforce this in law and also prevent these drugs being supplied privately.”

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